Endoscopic Closure of Fecal Colo-cutaneous Fistula by Using Metal Clips

Abstract

Fecal colo-cutaneous fistula often requires surgical intervention for successful closure increasing the morbidity and mortality associated with this condition. Endoscopic fistula closure can be a less invasive modality. We report successful closure of fecal colo-cutaneous fistula by endoscopic application of metal hemo-clips after failure of prolonged treatment including diverting proximal ileostomy in 2 consecutive patients after emergency primary repair of cecal perforation caused by stab injury of abdomen and iatrogenic fecal fistula after left hemicolectomy and colo-colic anastomosis for adenocarcinoma of descending colon, respectively. The endoscopic closure of fecal colo-cutaneous fistula by using metal clips is an effective, safe, and less invasive treatment modality. It can add to therapeutic armamentarium of surgeons and may obviate the need for additional surgical intervention and associated morbidity in a proportion of such patients.

Systematic Review of Cyanoacrylate Embolization for Refractory Gastrointestinal Fistulae

“…33,34 Fecal colocutaneous fistulae have also been reported to be successfully resolved with the use of metal clips. 35 Fibrin glue is probably the most widely used agent in the management of this condition. This is another biological component that has been found to achieve closure of low output 36 as well as high output GI fistulae nonoperatively.…”

Gastrointestinal perforations

“…In addition to perforation closure, clip closure has been reported to be successful in the closure of chronic fistulas such as the gastric-colocutaneous fistula after the removal of percutaneous endoscopic gastrostomy, colovesical fistula following diverticulitis, fecal fistula complicating appendicular abscess, and colocutaneous fistula following colectomy or necrotizing pancreatitis [60][61][62][63][64][65].…”

Anatomy-based surgical strategy of gastrointestinal fistula treatment

“…Endoscopic stenting has been mainly used with success in the esophagus, biliary tree, and pancreas, and stenting in proximal pancreatic fistulas is gaining acceptance after trauma [6,7]. Endoscopic closure of fecal colocutaneous fistulas using metal clips has also been described [8]. Percutaneous occlusion of low-output GI fistulas is also successful when the ideal conditions are met [9] (Fig.…”