Cic edizioni internazionali
Il Giornale di Chirurgia

Enterocutaneous fistula treatment: case report and review of the literature

Mini-Review, 143 - 151
doi: 10.11138/gchir/2018.39.3.143
Tag this article
Abstract
Full text PDF
Objective. The aim of this work is to evaluate the treatment strategies for a common major surgery complication like the enterocutaneous fistula (ECFs). Since there is not any standard treatment for this common disease and since new therapies, like NPWT and fibrin sealants, have come up a review of all their indications seemed useful. We also present two clinical cases treated in this way.
Patients and methods. A research was made in the principle databases such as: “Cochrane”, “Pubmed”, “Google Scholar” and “Google” using the following Key words “enterocutaneous fistula”, “fibrin glue”, “VAC”, “VAC treatment”, “fistula”, “conservative treatment”, “surgery” and using the MESH Function to search similar key words and expand the research. When two or more article with the same design were encountered (e.g. systematic reviews or case reports etc.) the newest one was chosen as data source.
Results. As far as somatostatine and its analogues are concerned, they showed a significant reduction of both time (13.95 vs 20.5 days) and percentage (72% vs 44%) of fistula closure against placebo in 2 meta-analysis. NPWT showed a high success rate between 90% and 100% but longer closure time between 4 weeks and 6 months. Fibrin glues showed heterogeneous results due to the great differencies in fistulas anatomy and treatment technique in the various studies, with 64-100% success rate in closure and a median 11,25 vs 23,25 days against total parenteral nutrition (TPN) alone.
Conclusions. Because of ECFs often come up in patient in bad conditions who are not fitted for surgery and because of their high Mortality and Morbidity, a multimodal approach is necessary. Although TPN is a cornerstone of their treatment, NPWT showed is superiority in reducing fistula output and in some cases leading to fistula closure, nevertheless it often needs long treating time. Fibrin glues often needs complex devices and are nota s good as NPWT in treating the around tissues, but they can be useful when fistulas are only accessible from a little external orifice or they show a complex branched tract; thus they are good when surgery is not possible and the fistula has a mid- or low- output.
The lack of prospective randomized studies or meta analysis and systematic review to compare the different methodics makes it impossible to show any evidence of superiority, but the combined application seems reasonable for a tailored treatment.

Vol. XL (No. 1) 2019 January - February

  1. Raffaele Bastianelli: Magister sine cathedra
    Di Matteo G.
  2. Thrombotic complications in inflammatory bowel diseases
    Fornaro R., Caristo G., Stratta E., Caratto M., Caratto E., Giovinazzo D., Di Maira L., Casaccia M., Frascio M.
  3. Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicentre observational study by the Italian ColoRectal Anastomotic Leakage (iC
    Benedetti M., Ciano P., Pergolini I., Ciotti S., Guercioni G., Ruffo G., Borghi F., Patriti A., Del Rio P., Scatizzi M., Mancini S., Garulli G., Carrara A., Pirozzi F., Scabini S., Liverani A., Baiocchi G., Campagnacci R., Muratore A., Longo G., Caricato M., Macarone Palmieri R., Vettoretto N., Caccaroni M., Guadagni S., Bertocchi E., Cianflocca D., Lambertini M., Pace U., Baraghini M., Pandolfini L., Angeloni R., Lucchi A., Martorelli G., Tirone G., Motter M., Sciuto A., Martino A., Luzzi A.P., Di Cesare T., Molfino S., Maurizi A., Marsanic P., Tomassini F., Santoni S., Capolupo G.T., Amodio P., Arici E., Clementi M., Ruggeri B., Catarci M.
  4. Open inguinal hernia repair with self-gripping Parietex ProGrip mesh: a retrospective study of 204 cases
    Del Papa M., D'Amata G., Manzi F., Carnì P., Florio G., Crovaro M., Musmeci L., Buonocore C.
  5. Use of the KSVM-based system for the definition, validation and identification of the incisional hernia recurrence risk factors
    Licari L., Salamone G., Campanella S., Carfì F., Fontana T., Falco N., Tutino R., De Marco P., Comelli A., Cerniglia D., Petrucci G., Vitabile S., Gulotta G.
  6. Colocutaneous fistula through ulcerative colitis and cancer to the pyoderma gangrenosum: a never-ending story for a single patient. Case report
    Eberspacher C., Mascagni D., Fralleone L., Maturo A., Di Matteo F.M., De Cristofaro F., Merletti D., Santoro A., Mascagni P., Pontone S., Pironi D.
  7. Amyand’s hernia: role of CT for a correct diagnosis
    Drago A., Carbone M., Lorusso V., Moschetta M., Scardapane A., Lucarelli N., Angelelli G., Stabile Ianora A.A.
  8. Modular megaprosthesis as definite treatment of femur osteomyelitis
    Koutserimpas C., Raptis K., Mari A., Kotsirakis A.
  9. Testicular torsion in a newborn: a case report
    Blevrakis E., Xenaki S., Chrysos E.
  10. Surveillance of pregnant women with potential exposure to Zika virus following travel
    Spiliopoulos D., Panchal M., Economides D.L.
  11. Mesenteric cyst and recurrent abdominal pain in a patient with Gorlin-Goltz syndrome: a case report
    Monaco L., Guida F., D'Onofrio G., Di Martino N.
  12. Squamous carcinoma in pilonidalis sinus: case report and review of literature
    Delvecchio A., Laforgia R., Sederino M.G., Minafra M., Carbotta G., Balducci G., Fabiano G., Fedele S., Palasciano N.
  13. congresses, academies, societies
    Di Matteo G.
Last Viewed articles: la lista degli ultimi x visitati.
  1. Enterocutaneous fistula treatment: case report and review of the literature
    Assenza M., Rossi D., De Gruttola I., Ballanti C.
    doi: 10.11138/gchir/2018.39.3.143
credits