Fibrin Glue Closure of Postoperative Enterocutaneous Fistulas.

Yoshimi, Fuyo; Asato, Yuji; Hidemura, Akio; Ikeda, Mami; Oka, Daiji; Tanaka, Toshiaki; Suzuki, Akifumi

doi:10.3919/jjsa.63.2869

Cited by 7 publications

(1 citation statement)

References 6 publications

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“…A fistula that communicates with a broken duodenal stump is one of the refractory complications after gastrectomy because of high output of digestive juice. Although conservative treatments for this condition (e.g., injection of fibrin glue into the ductal fistula and intravenous administration of factor XIII or somatostatin analogs) have been reported [1,2,12–14], generally surgeons consider conservative management and simple intraperitoneal drainage may be not sufficient, even for ductal fistula. Surgical approaches (e.g., open drainage of the broken stump, percutaneous transhepatic duodenal drainage, percutaneous transhepatic diversion of biliary flow, and duodenal drainage via T-tube placement into the broken stump) have been previously documented [1,5,7,15–17].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Labial Fistula Communicating with the Duodenal Stump After Gastrectomy

et al. 2019

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Patient: Male, 70 Final Diagnosis: Labial fistula Symptoms: Intractable discharge Medication: — Clinical Procedure: Intraluminal drainage via a rectus abdominis musculocutaneous flap Specialty: Surgery Objective: Unusual setting of medical care Background: Anastomotic failure after gastroenterological surgery is usually treated by intraperitoneal drainage and a mature ductal fistula. A ductal fistula may develop into a labial fistula. Although a ductal fistula is controllable, a labial fistula is intractable. We report a case of a labial fistula that communicated with the duodenal stump after gastrectomy. This condition was successfully treated by intraluminal drainage with continuous suction (IDCS) via a rectus abdominis musculocutaneous flap (RAMF). Case Report: A 70-year-old male underwent distal gastrectomy with intentional lymphadenectomy because of advanced gastric cancer. Digestive reconstruction was completed by the Billroth II method. Pancreatic leakage, intraperitoneal abscess, and anastomotic failure of gastrojejunostomy occurred after surgery. The duodenal stump was ruptured at postoperative day (POD) 26, and ductal fistula associated with the duodenum was observed. Unfortunately, this ductal fistula developed into a labial fistula at POD 90, and a high output of duodenal juice was observed. Additional surgery was proposed at POD 161. The broken stump and labial fistula were covered by a pedunculated RAMF, and a dual drainage system (a combination of a Penrose drain and a 2-way tube) travelled through the RAMF. The tip position of the drainage system was located in the duodenum, and the IDCS was effectively introduced. The secondary ductal fistula finally matured through the RAMF, and was subsequently closed at POD 231. The intractable labial fistula was successfully treated, and the patient was discharged at POD 235. Conclusions: A high-output labial fistula, which communicated with the duodenal stump after gastrectomy, was refractory in our patient. Effective IDCS through an RAMF was useful for replacement of the labial fistula with a secondary ductal fistula.

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