Percutaneous intestinal drainage for a refractory enterocutaneous fistula: A case report.

INTRODUCTION: Enterocutaneous fistulas (ECFs) that occur following gastrointestinal surgery require long-term hospitalization, and treatment may be difficult in rare cases. Although the morbidity and mortality associated with ECF have decreased with modern medical, the overall mortality is still surprisingly high, up to 30.4 %.

PRESENTATION OF CASE: The patient was a 79-year-old male who had undergone laparoscopic sigmoidoscopy for sigmoid colon cancer 5 years previously. He was newly diagnosed with sigmoid colon cancer 5 years following surgery. A laparoscopic high anterior resection was performed. On the 4th postoperative day, he was diagnosed with a suture failure which was treated conservatively; however, the fistula could not be closed, and ileostomy construction was performed. Intestinal fluid leaked from the median surgical incision, leading to the formation of a small intestinal fistula on the proximal side from the ileostomy. Conservative treatment did not improve the condition and skin erosion worsened. Two months after the stoma was constructed, a urethral balloon catheter was percutaneously inserted into the intestinal tract from the small intestinal fistula to drain the intestinal fluid. Following the maneuver, the problem of skin erosion was improved, with the resulting closure of the fistula.

DISCUSSION: The basic principles underlying treatment for ECFs are essentially fasting, drainage, and adequate nutritional management. Some studies reported that the average period of negative pressure therapy was four weeks. It seems that four weeks is the breakpoint.

CONCLUSION: Percutaneous intestinal drainage for refractory ECFs following gastrointestinal surgery is minimally invasive and is likely to be extremely useful.