Digestive System Fistula - A Problem Still Relevant Today

Abstract

Digestive system fistula originates most frequently as a complication after surgical procedures, less often occurs in the course of inflammatory diseases, but it can also result from neoplasm and injuries. THE AIM OF THE STUDY was to analyze the causes and retrospectively assess the perioperative procedures as well as the results of digestive system fistula treatment. MATERIAL AND METHODS. Own experience in digestive system fistula treatment was presented. The subject group consisted of 32 patients treated at the General Surgery, Oncology and Endocrinology Clinical Department between 01.05.2005 and 30.04.2010 due to different digestive tract diseases. The causes of the occurrence of digestive system fistula, methods and results of treatment were analyzed. RESULTS. The analysis covered 32 patients with digestive system fistula, among them 15 men and 17 women. Average age for men was 57 years (20-78), and for women 61 years (24-88). In 11 patients idiopathic fistula causally connected with primary inflammatory disease (7 cases) and with neoplasm (4 cases) was diagnosed, in 19 patients fistula was the result of complications after surgery, in 2 - after abdominal cavity injury. Recovery from fistula was achieved in 23 patients (72%) with the use of individually planned conservative therapy (TPN, EN, antibiotics, drainage, and others) and surgery, depending on the needs of individual patient. 5 patients (16%) died, whereas in 4 left (12%) recovery wasn't achieved (fistula in palliative patients, with advanced stages of neoplasm - bronchoesophageal fistula, the recurrence of uterine carcinoma). CONCLUSIONS. Recently the results of digestive system fistula treatment showed an improvement which manifests itself in mortality decrease and shortening of fistula healing time. Yet, digestive system fistula as a serious complication still poses a very difficult surgical problem.

Multiple Visceral Resections for Synchronous Left and Transverse Colon Adenocarcinoma with Gastrocolic-cutaneous Fistula – Case Report and Literature Review

“…In all four cases, conservative management was attempted, consisting of antibiotic treatment, parenteral nutrition, analgesic drugs, proton pump inhibitors and gastrostomy tube placement (in one case), followed by palliative care. In other seven cases, intestinal fistulas were reported and were surgically managed in most cases; however, in all these cases the underlying process which induced the development of fistula consisted of inflammatory bowel disease and not a neoplastic process, all patients having a good postoperative outcome (34).…”

“…The other particularity of our case was the association of a complex gastrocolic-cutaneous fistula at the time of presentation. Usually seen during the postoperative or postprocedural periods, complex digestive tract fistulas also occur in patients with inflammatory bowel disease or advanced neoplastic processes (8)(9)(10)(11)(31)(32)(33)(34). In the study conducted by Gluszek et al and published in 2011, 32 patients with digestive tract fistulas were included; among these cases, association of a neoplastic process was seen in four and consisted of bronchoesophageal fistula due to pulmonary or esophageal carcinoma in three cases and an enterovaginal fistula due to an anal carcinoma in one case.…”

Anastomotic Leaks after Colorectal Surgery: a Prognostic Score

“…Th eir bad prognosis of the patient's condition, the diffi culties of early diagnosis and the optimal choice of the therapeutic method turn them into an issue of great interest. About a third of the deaths occur due to digestive anastomoses following fi stulas [4].…”

“…Th e Charlson comorbidity index was calculated for each patient included in the study according to the method presented by Hall and Ramachandran [4].…”

Retrospective analysis of the effects of continuous intraluminal aspiration on postoperative intestinal fistulas

“…Other studies have reported that antibiotic therapy and medical treatments that decrease GI tract secretions, such as somatostatin, are useful to treat these same patient groups [16,17].…”