The Use of Minimally Invasive Surgery As a Treatment for Colocutaneous Fistula Case Report

Ahmed Hammad, MR, Hitham Qandeel, FRCS, Hitham Abudeep, MR, Arijit Mukherjee, FRCS, Ali Amin, Mr, C Murch, Dr. GeneralL Surgery Department Hairmyres Hospital, Glasgow

 

Aim:
We report a case of successful management of a benign colocutaneous fistula following an anastamotic stricture treated by repeated endoscopic dilatation, placement of self-expandable metal stents (SEMS) and percutaneous ethanol injection (PEI).
Case presentation:
54 year white lady developed a colocutaneous fistula at the anastamotic stricture site following reversal of Hartmann’s procedure for diverticular disease.
Given the fact that the patient was not keen on surgery and having another stoma, in addition to her morbid obesity, a decision was made to manage her conservatively in the form of repeated flexible sigmoidoscopy and balloon dilation. The patient improved symptomatically but the fistula was persistent. A decision was made to place SEMS endoscopically and at the same time ethanol was injected percutaneously through the fistulous tract with continuous rectal saline irrigation.
The procedure was done without complications. A month later, the fistula healed which was confirmed on contrast study.
One year follow up did not show any clinical symptoms or signs of recurrence.
Conclusion:
To our knowledge, this is the ?rst case demonstrating SEMS combined with PEI as a curative and potentially permanent alternative for benign postoperative ?stulae. This approach is very attractive for patients unfit for surgery, although a longer follow up and further studies will be needed
 


Session Number: Poster – Poster Presentations
Program Number: P116
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