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Non-healing post-surgical fistulae: treatment with image-guided percutaneous injection of cyanoacrylic glue

  • ABDOMINAL RADIOLOGY
  • Published:
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Abstract

Objectives

To present the results of our experience with cyanoacrylic glue percutaneous injection to treat post-surgical non-healing enteric fistulae after failure of standard treatments.

Methods

Eighteen patients (14 males; age range 33–84, mean 69 years) were treated for a non-healing post-surgical enteric fistula after failure of standard treatments. Under computed tomography and/or fluoroscopic guidance, a mixture of cyanoacrylic glue (Glubran 2, GEM, Viareggio, Italy) and ethiodized oil was injected at the site of the fistula. Fistula was considered healed when no material was drained by the percutaneous drainage and a subsequent computed tomography confirmed the disappearance of any fluid collection.

Results

In all cases, it was possible to reach the site of the fistula using a percutaneous access. A median of 1 injection (range 1–5) was performed. Fistula healing was achieved in 16/18 (89 %) patients. One patient died for other reasons before fistula healing. Median time for fistula healing was 0 days (mean 8, range 0–58 days). No complications occurred. Reoperation was needed in one patient.

Conclusions

Percutaneous injection of cyanoacrylic glue is feasible, safe, and effective to treat non-healing post-surgical enteric fistulae. It may represent a further option to avoid surgical reoperation in frail patients.

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References

  1. Girard E, Messager M, Sauvanet A, Benoist S, Piessen G, Mabrut JY et al (2014) Anastomotic leakage after gastrointestinal surgery: diagnosis and management. J Visc Surg 151:441–450

    Article  CAS  PubMed  Google Scholar 

  2. Joyce MR, Dietz DW (2009) Management of complex gastrointestinal fistula. Curr Probl Surg 46:384–430

    Article  PubMed  Google Scholar 

  3. Schecter WP, Hirshberg A, Chang DS, Harris HW, Napolitano LM, Wexner SD et al (2009) Enteric fistulas: principles of management. J Am Coll Surg 209:484–491

    Article  PubMed  Google Scholar 

  4. Falconi M, Pederzoli P (2001) The relevance of gastrointestinal fistulae in clinical practice: a review. Gut 49(Suppl 4):iv2–iv10

    PubMed  PubMed Central  Google Scholar 

  5. Berry SM, Fischer JE (1994) Enterocutaneous fistulas. Curr Probl Surg 31:469–566

    Article  CAS  PubMed  Google Scholar 

  6. Jacobsen HJ, Nergard BJ, Leifsson BG, Frederiksen SG, Agajahni E, Ekelund M et al (2014) Management of suspected anastomotic leak after bariatric laparoscopic Roux-en-y gastric bypass. Br J Surg 101:417–423

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Kumar N, Thompson CC (2013) Endoscopic therapy for postoperative leaks and fistulae. Gastrointest Endosc Clin N Am 238:123–136

    Article  Google Scholar 

  8. Mauri G, Mattiuz C, Sconfienza LM, Pedicini V, Poretti D, Melchiorre F et al (2014) Role of interventional radiology in the management of complications after pancreatic surgery: a pictorial review. Insights Imaging 6:231–239

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mauri G, Michelozzi C, Melchiorre F, Poretti D, Tramarin M, Pedicini V et al (2013) Biodegradable biliary stent implantation in the treatment of benign bilioplastic-refractory biliary strictures: preliminary experience. Eur Radiol 23:3304–3310

    Article  PubMed  Google Scholar 

  10. Pedicini V, Poretti D, Mauri G, Trimboli M, Brambilla G, Sconfienza LM et al (2010) Management of post-surgical biliary leakage with percutaneous transhepatic biliary drainage (PTBD) and occlusion balloon (OB) in patients without dilatation of the biliary tree: preliminary results. Eur Radiol 20:1061–1068

    Article  PubMed  Google Scholar 

  11. Cozzaglio L, Cimino M, Mauri G, Ardito A, Pedicini V, Poretti D et al (2011) Percutaneous transhepatic biliary drainage and occlusion balloon in the management of duodenal stump fistula. J Gastrointest Surg 15:1977–1981

    Article  PubMed  Google Scholar 

  12. Kwon SH, Oh JH, Kim HJ, Park SJ, Park HC (2008) Interventional management of gastrointestinal fistulas. Korean J Radiol 9:541–549

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kelogrigoris M, Sotiropoulou E, Stathopoulos K, Georgiadou V, Philippousis P, Thanos L (2011) CT-guided percutaneous drainage of infected collections due to gastric leak after sleeve gastrectomy for morbid obesity: initial experience. Cardiovasc Intervent Radiol 34:585–589

    Article  CAS  PubMed  Google Scholar 

  14. Laganà D, Carrafiello G, Mangini M, Ianniello A, Giorgianni A, Nicotera P et al (2008) Image-guided percutaneous treatment of abdominal-pelvic abscesses: a 5-year experience. Radiol Med 113:999–1007

    Article  PubMed  Google Scholar 

  15. Mauri G, Sconfienza LM (2013) A few thoughts on ‘Interventional radiology in the management of benign biliary stenoses, biliary leaks and fistulas: a pictorial review’. Insights Imaging 4:253

    Article  PubMed  PubMed Central  Google Scholar 

  16. Mauri G, Michelozzi C, Melchiorre F, Poretti D, Pedicini V, Salvetti M et al (2016) Benign biliary strictures refractory to standard bilioplasty treated using polydoxanone biodegradable biliary stents: retrospective multicentric data analysis on 107 patients. Eur Radiol 26:4057–4063

    Article  PubMed  Google Scholar 

  17. Ching SS, Muralikrishnan VP, Whiteley GS (2003) Relaparotomy: a five-year review of indications and outcome. Int J Clin Pract 57:333–337

    CAS  PubMed  Google Scholar 

  18. Mauri G, Sconfienza LM, Fiore B, Brambilla G, Pedicini V, Poretti D et al (2013) Post-surgical enteric fistula treatment with image-guided percutaneous injection of cyanoacrylic glue. Clin Radiol 68:59–63

    Article  CAS  PubMed  Google Scholar 

  19. Mathes SJ, Bostwick J (1977) A rectus abdominis myocutaneous flap to reconstruct abdominal wall defects. Br J Plast Surg 30:282–283

    Article  CAS  PubMed  Google Scholar 

  20. Gerzof SG, Robbins AH, Birkett DH, Johnson WC, Pugatch RD, Vincent ME (1979) Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography. AJR Am J Roentgenol 133:1–8

    Article  CAS  PubMed  Google Scholar 

  21. Binmoeller KF, Grimm H, Soehendra N (1993) Endoscopic closure of a perforation using metallic clips after snare excision of a gastric leiomyoma. Gastrointest Endosc 39:172–174

    Article  CAS  PubMed  Google Scholar 

  22. Law R, Wong Kee Song LM, Irani S, Baron TH (2015) Immediate technical and delayed clinical outcome of fistula closure using an over-the-scope clip device. Surg Endosc 29:1781–1786

    Article  PubMed  Google Scholar 

  23. El Hajj II, Imperiale TF, Rex DK, Ballard D, Kesler KA, Birdas TJ et al (2014) Treatment of esophageal leaks, fistulae, and perforations with temporary stents: evaluation of efficacy, adverse events, and factors associated with successful outcomes. Gastrointest Endosc 79:589–598

    Article  PubMed  Google Scholar 

  24. Rogalski P, Daniluk J, Baniukiewicz A, Wroblewski E, Dabrowski A (2015) Endoscopic management of gastrointestinal perforations, leaks and fistulas. World J Gastroenterol 21:10542–10552

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Kotzampassi K, Eleftheriadis E (2015) Tissue sealants in endoscopic applications for anastomotic leakage during a 25-year period. Surgery 157:79–86

    Article  PubMed  Google Scholar 

  26. Rábago LR, Ventosa N, Castro JL, Marco J, Herrera N, Gea F (2002) Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue. Endoscopy 34:632–638

    Article  PubMed  Google Scholar 

  27. Goenka MK, Goenka U (2015) Endotherapy of leaks and fistula. World J Gastrointest Endosc 7:702–713

    PubMed  PubMed Central  Google Scholar 

  28. Bae JH, Kim GC, Ryeom HK, Jang YJ (2011) Percutaneous embolization of persistent biliary and enteric fistulas with Histoacryl. J Vasc Interv Radiol 22:879–883

    Article  PubMed  Google Scholar 

  29. Carrafiello G, Ierardi AM, Piacentino F, Cardim LN (2012) Percutaneous transhepatic embolization of biliary leakage with N-butyl cyanoacrylate. Indian J Radiol Imaging 22:19–22

    Article  PubMed  PubMed Central  Google Scholar 

  30. Nennstiel S, Weber A, Frick G, Haller B, Meining A, Schmid RM et al (2015) Drainage-related complications in percutaneous transhepatic biliary drainage: an analysis over 10 years. J Clin Gastroenterol 49:764–770

    Article  PubMed  Google Scholar 

  31. Rahman FN, Stavas JM (2015) Interventional radiologic management and treatment of enterocutaneous fistulae. J Vasc Interv Radiol 26:7–19

    Article  PubMed  Google Scholar 

  32. Vagner EA, Orlov VA (1972) Surgical treatment of vesicovaginal fistulas using cyanoacrylate glue. Khirurgiia 49:53–57

    CAS  PubMed  Google Scholar 

  33. Cothren CC, McIntyre RC, Johnson S, Stiegmann GV (2004) Management of low-output pancreatic fistulas with fibrin glue. Am J Surg 188:89–91

    Article  PubMed  Google Scholar 

  34. Ekeh AP, Walusimbi M, Brigham E, Woods RJ, McCarthy MC (2010) The prevalence of incidental findings on abdominal computed tomography scans of trauma patients. J Emerg Med 38:484–489

    Article  PubMed  Google Scholar 

  35. Lisle DA, Hunter JC, Pollard CW, Borrowdale RC (2007) Percutaneous gelfoam embolization of chronic enterocutaneous fistulas: report of three cases. Dis Colon Rectum 50:251–256

    Article  PubMed  Google Scholar 

  36. Cambj Sapunar L, Sekovski B, Matić D, Tripković A, Grandić L et al (2012) Percutaneous embolization of persistent low-output enterocutaneous fistulas. Eur Radiol 22:1991–1997

    Article  PubMed  Google Scholar 

  37. Loffroy R (2016) Glubran2(®), Histoacryl(®) or Trufill(®): which cyanoacrylate glue for endovascular use? Diagn Interv Imaging 97:119

    Article  CAS  PubMed  Google Scholar 

  38. López J, Rodriguez K, Targarona EM, Guzman H, Corral I, Gameros R et al (2015) Systematic review of cyanoacrylate embolization for refractory gastrointestinal fistulae: a promising therapy. Surg Innov 22:88–96

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy

    Giovanni Mauri

  2. Department of Interventional Radiology, European Institute of Oncology, Via Ripamonti 435, 20100, Milan, Italy

    Giovanni Mauri

  3. Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy

    Lorenzo C. Pescatori & Chiara Mattiuz

  4. Department of Radiology, Humanitas Research Hospital, Rozzano, 20089, Milan, Italy

    Dario Poretti & Vittorio Pedicini

  5. Department of Radiology, San Paolo Hospital, Via Antonio di Rudinì, 8, 20142, Milan, Italy

    Fabio Melchiorre

  6. Division of Radiology and Interventional Radiology, Department of Diagnostic Sciences, San Carlo Borromeo Hospital, Via Pio II 3, 20153, Milan, Italy

    Umberto Rossi

  7. Humanitas University, Rozzano, 20089, Milan, Italy

    Luigi Solbiati

  8. Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Pascal 36, 20133, Milan, Italy

    Luca Maria Sconfienza

  9. Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy

    Luca Maria Sconfienza

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  1. Giovanni Mauri
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  2. Lorenzo C. Pescatori
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  3. Chiara Mattiuz
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  9. Luca Maria Sconfienza
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Correspondence to Giovanni Mauri.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was waived by the relevant Institutional Review Board.

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Cite this article

Mauri, G., Pescatori, L.C., Mattiuz, C. et al. Non-healing post-surgical fistulae: treatment with image-guided percutaneous injection of cyanoacrylic glue. Radiol med 122, 88–94 (2017). https://doi.org/10.1007/s11547-016-0693-7

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  • DOI: https://doi.org/10.1007/s11547-016-0693-7

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