Radiographic and Endoscopic Diagnosis and Treatment of Enterocutaneous Fistulas

Abstract

The management of enterocutaneous fistulas continues to be a challenging postoperative complication. Understanding the anatomy of the fistula optimizes its evaluation and management. Diagnostic radiology has always played an important role in this task. The use of plain radiography with contrasted studies and fistulograms is well documented in the earliest investigations of fistulas and they continue to be helpful techniques. The imaging techniques have evolved rapidly over the past 15 years with the introduction of cross-sectional imaging, ultrasound and endoscopy. The purpose of this chapter is to review both the diagnostic and therapeutic roles of fistulograms, small bowel follow-through, computed tomography, magnetic resonance imaging, ultrasound, and endoscopy in the setting of acquired enterocutaneous fistulas.

Malignant Colojejunal Fistula First Discovered on CT: A Case Report

“…The main drawback of CTE over routine CT is that the former may miss small abscesses as they are obscured by the negative luminal contrast making it difficult to identify them amidst the low attenuation bowel loops. Hence routine CT is superior to CTE in identifying smaller abscesses [6]. The coexistence of fistula with intra abdominal abscess is reported to be 44%.…”

Fistuloclysis

“…If the fi stulogram fails to provide the needed information, a small bowel follow-through or computed tomographic scan can be conducted. 26 Despite the lack of literature on this topic, experienced WOC nurses and RDNs must work closely in the management of this patient population. Together they can determine the ideal route for nutrition.…”

Hepatogastric fistula following amoebic liver abscess: an extremely rare and difficult situation

“…Rapid enlargement of abscess cavity, vomiting or Ryle's tube aspirate containing typical anchovy sauce pus, passage of amoebic pus per rectum and presence of gastric contents in aspirated material from abscess cavity may indicate toward hepatogastric fistula 5,8 . USG or CECT may show liver abscess with multiple air foci and CECT may also show any communication between abscess cavity and stomach 9,10 . Possible sources of air within liver abscess include infection with gas-forming organisms, bland tissue infarction with necrosis, enteric fistula formation and recent instrumentation or surgery 11 .…”

“…Rarely upper GI contrast may show a fistulous tract between the abscess cavity and the stomach 2,5 . Upper GI contrast studies may fail to identify the fistula location, if the majority of the contrast passes swiftly, or if the fistula orifice is small or obstructed at the time of study 10 . Endoscopy may reveal gastric openings of the fistulous tract, but this modality has rarely been reported as a diagnostic modality for GI fistulas…”

“…Identification of the intraluminal orifice of the fistula by endoscopy is difficult without the help of other imaging modalities 10 . Usually USG and CECT are done initially and the rest of the investigations are added according to need 10 . In our case, upper GI contrast study and endoscopy were negative.…”