Spontaneous Enterocutaneous Fistula 27-years Following Radiotherapy in a Patient of Carcinoma Penis

Abstract

BackgroundRadiotherapy in the radical doses can produce severe and often irreversible damage to the gut in the form of fibrosis, necrosis and fistulae formation. A previous pelvic surgery makes the gut extra-vulnerable. This is on account of adhesions to the pelvic wall, unless special care is taken during surgery to keep it out of the harms way, during adjuvant radiotherapy. These effects range from acute, to sub acute and delayed chronic manifestations like in the reported case.Case reportA spontaneous low out put enterocutaneous fistula in a 68-year-old man following surgery and adjuvant radiotherapy given 27 years back for carcinoma penis is reported. Patient is making a satisfactory progress after three years of follow-up.ConclusionHigh dose external beam radiotherapy is known to produce deleterious side effects ranging from mild radiation enteritis to the development of internal and external fistulae. The effects may be acute, subacute or chronic. Presentation as spontaneous enterocutaneous fistula 27 years after radiotherapy is rare.

Appendicular tuberculosis presenting as enterocutaneous fistula over thigh—A rare case report with review of literature

“…Though Spontaneous enterocutaneous fistula over scar of a previous appendicectomy has been reported [5], this is to our knowledge first case presenting primarily as spontaneous enterocutaneous fistula over front of right thigh. Barium studies and CECT can show the actual tract of the fistula and also locate any associated pathology [6].…”

Spontaneous tubercular enterocutaneous fistula developing in the scar of a surgery done 14 years earlier

“…[ 3 4 ] Spontaneous tubercular enterocutaneous fistulae, in the strict sense, are not spontaneous, as their development is secondary to underlying intestinal diseases. Such conditions include Crohn disease,[ 5 ] malignancy,[ 6 ] infectious processes such as tuberculosis[ 7 ] and typhoid fever,[ 8 ] radiation exposure,[ 9 ] diverticulitis, vascular insufficiency, and mesenteric ischemia. [ 10 ] Other causes include diverticulosis, appendicitis, pancreatitis[ 4 ] and, in rare instances, congenital hernias[ 11 ] and even Littré hernia.…”

“…[ 11 ] Drainage of associated intra-abdominal abscesses, along with appropriate antibiotic therapy, is also essential. [ 9 ] While some fistulae close spontaneously with medical management alone, many require surgical intervention. [ 10 ] As is the case with perforation in intestinal TB, tubercular enterocutaneous fistula can also be treated with fistulectomy and resection of the involved segment of intestine followed by an end-to-end anastomosis.…”

Management of Enterocutaneous Fistula: A Review

“…The etiology of ECFs can thus be characterized as postoperative, traumatic, or spontaneous. 5 Anatomically ECF can be divided into internal and external fistulas and this helps in identifying the organs involved and providing characteristics of the fistula tract. Internal fistulas have communications between two hollow viscera which if symptomatic should be treated by resection and re-anastomosis.…”

“…4 Breaching the cycle of tissue inflammation, infection, and sepsis plays a key role within the approach of those complex patients. 5 Free Full Text Articles are Available at www.jnma.com.np…”