Intravenous Phenytoin: Possible New Therapy for Gastro-intestinal Fistlae

Saed A Jaber, MD, Hasan A Yami, MD, Basma M Fallatah, MD, Mahmoud Abdelmoeti, MD. KING FAHD MEDICAL MILITARY COMPLEX

Gastro-Intestinal fistulae are among the most devastating complications after GI surgery. Their subsequent development can be lethal. We report 13 cases of GI fistulas treated with Intravenous phenytoin. Fistula tract healing consists of several processes, including cell migration and the formation of a new extracellular matrix. Multiple studies have shown that phenytoin can promote wound healing and induce faster fibrosis. We postulate that such a positive effect can be used to enhance fibrosis of the fistula tract. We treated 13 patients who had developed GI fistulae as a complication from surgical intervention .Five patients developed external small Intestinal fistulae, 2 colonic, 2 pancreatic, 1 biliary, 3 gastrocutenous fistulas. Patients were started on IV phenytoin in the first 4 day and then switched to oral phenytoin. A Significant drop in output was noticed 3 -4 days after treatment. All Fistulae healed in a short period averaging 8 days without the need for a surgical intervention. In conclusion, Intrvenous phenytoin may have a positive effect in the treatment of fistulas. Prospective studies are needed to indicate this possible effect of phenytoin on fistula healing.

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