Percutaneous embolization of persistent low-output enterocutaneous fistulas
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To present and retrospectively evaluate the technique of percutaneous embolization of chronic enterocutaneous fistulas (ECFs) using n-butyl-2-cyanoacrylate and Lipiodol under fluoroscopic guidance.
Six patients with a total of seven post-operative low-output ECFs of the large intestine were treated. After fistulography a hydrophilic guide wire and a catheter were advanced through the ECF into the intestine. After dilation of the bowel with saline and contrast medium, the catheter was withdrawn into the enteric orifice and glue together with Lipiodol was injected while simultaneously pulling the catheter.
Complete closure of all seven fistulas was achieved. There were no peri-procedural complications. In one patient 1 month following embolization a low-output enteric discharge was observed, but the ECF spontaneously healed 5 days later. In one patient 18 months after the embolization a new perforation due to diverticulitis close to the embolization site occurred and resection of the sigmoid colon was performed. One patient needed reoperation due to a recurrence of rectal carcinoma.
In our series of patients, the presented technique of percutaneous embolization proved to be efficacious and easy to perform. It may have potential as a first-line treatment of low-output ECFs but a prospective study with a larger series of patients and a longer follow-up is required.
• Patients with low-output fistulas have recurrent infections and reduced quality of life.
• Surgical treatment is complex with a relatively high morbidity and occasional mortality.
• Several percutaneous and endoscopy treatments have previously been proposed with mixed results.
• Hydrophilic guide wires and hydrophilic catheters offer new potential treatment options.
• Sealing the fistula with cyanoacrylate glue and Lipiodol seems potentially efficacious.
KeywordsEnterocutaneous fistula Post-operative complications Therapeutic embolization Ethiodized oil Tissue adhesives
- 6.The Canadian Asocciation for Enterostomal Therapy (2009) Best practice recommendations for management of enterocutaneous fistulae. The Canadian Asocciation for Enterostomal Therapy. Available via http://www.caet.ca/caet-english/documents/caet-best-et-practices.pdf. Accessed 15 Dec 2011