European Radiology

, Volume 22, Issue 9, pp 1991–1997 | Cite as

Percutaneous embolization of persistent low-output enterocutaneous fistulas

  • Liana Cambj Sapunar
  • Budimir Sekovski
  • Dario Matić
  • Andro Tripković
  • Leo Grandić
  • Nikica Družijanić
Interventional

Abstract

Objectives

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.

Methods

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 After dilation of the bowel with saline and contrast medium, the catheter was withdrawn into the enteric orifice and glue together with Lipiodol was injected while simultaneously pulling the catheter.

Results

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.

Conclusions

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.

Key Points

• 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.

Keywords

Enterocutaneous fistula Post-operative complications Therapeutic embolization Ethiodized oil Tissue adhesives 

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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Liana Cambj Sapunar
    • 1
  • Budimir Sekovski
    • 1
  • Dario Matić
    • 2
  • Andro Tripković
    • 2
  • Leo Grandić
    • 2
  • Nikica Družijanić
    • 2
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Hospital SplitSplitCroatia
  2. 2.Department of SurgeryUniversity Hospital SplitSplitCroatia

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