Continuous irrigation and suction with a triple-cavity drainage tube in combination with sequential somatostatin–somatotropin administration for the management of postoperative high-output enterocutaneous fistulas

Abstract

Introduction: Enterocutaneous fistula is considered one of the most serious complications in general surgery and is associated with high morbidity and mortality. Although various treatments are reported to have varying success, high-output enterocutaneous fistulas (output over 500 ml/day) continue to be associated with high mortality, and few papers on this topic exist in the literature. The aim of this study is to describe an effective multidisciplinary treatment method for postoperative high-output enterocutaneous fistula and discuss the clinical development of the therapeutic strategy. Patient concerns: Three patients suffered high-output enterocutaneous fistulas, in which case 1 presented with duodenal fistula, case 2 with ileal fistula, and case 3 with small bowel fistula. Diagnosis : All 3 cases were diagnosed with high-output enterocutaneous fistulas by drainage of intestinal contents. Interventions: With the exception of routine treatment including fluid resuscitation, correction of the electrolyte balance, control of infection, and optimal nutrition, all the cases accepted continuous irrigation and suction with triple-cavity drainage tubes in combination with sequential somatostatin–somatotropin administration were given. With regard to establishing effective drainage, the triple-cavity tube placement was performed by insertion through the initial drainage channel in case 1, percutaneous puncture with dilation by graduated dilators in case 2, and tract reconstruction in case 3. The technical details of the approach are described and clinical characteristics including fistula location, defect size, output volume, approach of triple-cavity tube placement, length of fistula tract, somatostatin and somatotropin administration time, and fistula healing time were recorded and compared. In addition, other various techniques reported in the literature are reviewed and discussed. Outcomes: All the patients were cured by the multidisciplinary treatments and were followed up without fistula recurrence and other relevant complications at 1 week, 1 month, and 3 months after the treatments. Conclusion: The strategy involving continuous irrigation and suction with a triple-cavity drainage tube in combination with sequential somatostatin–somatotropin administration may be a safe and effective alternative treatment for postoperative high-output enterocutaneous fistula and a more practical method that is easy to execute to manage this problem. Long-term studies, involving more patients, are still necessary to confirm this suggestion.

Application Effect of Somatostatin Combined with Transnasal Ileus Catheterization in Patients with Acute Intestinal Obstruction and Advanced Gastric Cancer

“…Lin et al [ 21 ] used transnasal intestinal obstruction catheterization to treat acute intestinal obstruction caused by Yellowstone, which can significantly control the disease progression and relieve abdominal distention and pain. Kong et al [ 22 ] applied continuous aspiration and infusion of a three-chamber drainage tube combined with somatostatin for acute intestinal obstruction, which can significantly reduce the intestinal lumen pressure. At the same time, it can relieve the blockage of fibrous tissue, improve the gastrointestinal environment, and improve the effective rate of treatment.…”

Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study

“…Other barriers in nursing care of patients with ECF were finding the missing tools, such as the suction devices to connect to the dressing or getting hold of the hospital's enterostomal therapy nurses. An integrative approach between critical care nurses and ostomy nurses is recommended as appropriate 21 . The participant indicated challenges with regulating pressure on the suction apparatus used for negative pressure wound dressings.…”

“…The dressings do not stick; gastrointestinal juice leakages result in a bad odor, and critical care nurses found difficulty in hiding or expressing feelings. 21 , 35 The enteric contents become problematic when more fluid than solid comes from the enterocutaneous fistula. Applying the stoma bag over the fistula becomes difficult.…”

“…An integrative approach between critical care nurses and ostomy nurses is recommended as appropriate. 21 The participant indicated challenges with regulating pressure on the suction apparatus used for negative pressure wound dressings. The negative pressure wound dressings are recommended for managing patients with enterocutaneous fistula.…”

Initial suction drainage decreases severe postoperative complications after pancreatic trauma: A cohort study

“…The outer cannula can prevent both aspiration damage to surrounding tissues and blockage of the inner suction cannula. The patency provided by NPI suction drainage is a fundamental principle in the formation of a stable and controlled pancreaticocutaneous or enterocutaneous fistula, which is beneficial for facilitating the formation of the fistula tract[ 24 ].…”