Successful treatment of enterocutaneous fistula after esophagectomy with scopolamine ointment and negative pressure wound therapy: a case report

Abstract

Background: Despite improved surgical techniques and perioperative management, anastomotic leakage (AL) after esophageal cancer surgery remains a potential complication. In most cases, spontaneous healing upon proper drainage is observed, but sometimes, AL results in intractable enterocutaneous fistulas. We here report a case of intractable enterocutaneous fistula caused by post-esophagectomy AL and successfully treated by scopolamine ointment and negative pressure wound therapy (NPWT). Case presentation: A 77-year-old man underwent thoracoscopic subtotal esophagectomy with 3-field lymph node dissection, followed by gastric tube reconstruction through the posterior mediastinal route. On the 6th postoperative day, AL was identified, forming an enterocutaneous fistula. Initially, conservative treatment was performed, but the fistula failed to close. We hypothesized that the substantial amount of exudate might be hampering fistula closure. Scopolamine ointment was used to reduce the amount of fluid. NPWT was also initiated to promote wound healing. Approximately 3 weeks after the beginning of the treatment, the fistula closed; oral intake became possible, and the patient was discharged from the hospital without any symptoms. Conclusions: The combination of scopolamine ointment and NPWT may be regarded as one effective treatment option for intractable enterocutaneous fistula due to AL after esophagectomy.

Non-Surgical Strategies for Assisting Closure of Pharyngocutaneous Fistula after Total Laryngectomy: A Systematic Review of the Literature

“…However, in our literature search anticholinergic drugs were reported for the treatment of neurological chronic drooling [ 51 , 52 ], or for the prevention of sialocele or the treatment of salivary fistulas following parotid surgery [ 53 , 54 ], while no mention as a possible treatment for PCF was found. For the sake of completeness, we found that successful use of combination treatments, such as scopolamine + botulinum toxin for a post-parotidectomy fistula [ 55 ], or scopolamine + NPWT for treating an entero-cutaneous fistula after esophagectomy [ 56 ], was also presented in case reports.…”

Fístula enterocutánea: un enfoque desde las generalidades y el estado nutricional

“…Este tratamiento debe iniciarse de manera gradual, evaluando las presiones para evitar el riesgo de isquemia de los tejidos y el desarrollo de fístulas. Los pegamentos biológicos de fibrina están indicados cuando el paciente presenta una fistula de mediano o bajo gasto y la cirugía no es una opción terapéutica 24 .…”

Application Site of Transdermal Scopolamine Influences Efficacy and Drug Concentration in Salivary Glands in Rats

“…22,24,25) In Japan, scopolamine ointments, which are hospital preparations, are used as alternatives, because scopolamine patches are not approved and are not commercially available. [26][27][28] Scopolamine patches and ointments are applied to the posterior auricle, which is the most absorbent area, 29) and the patches are used once every 3 d and the ointments once or twice a day. [26][27][28] However, the duration of action of scopolamine ointment has not yet been scientifically verified.…”