Treatment of enterocutaneous fistula with total parenteral feeding in combination with octreotide: a case report

Abstract

IntroductionThe diagnosis and classification of fistulas based on anatomy, physiology and etiological criteria is the first important stage, conservative treatment consists on patient's stabilization. Finally, on complicated cases, when spontaneous closure fails, specific surgical approach should be applied.Case presentationA 50 years-old women patient underwent four surgical interventions from the bowel gangrene, caused from the superior mesenteric vein thrombosis consequences. After fourth surgical intervention, at eighth post-operative day, the enterocutaneous fistula developed. On 20-th day, after enterocutaneous fistula developed, together with TPN, we administered also octreotide (100 micrograms/8 hours), for 48 hours. The reduction of fistula output, after treatment of TPN in combination with octreotide, compare the treatment only with TPN, was not significant (p < 0, 05). The enterocutaneous fistula, developed after fourth operation, has been spontaneously closed after four months.ConclusionThe fistula output, after treatment of TPN in combination with octreotide, compared with the treatment only with TPN, wasn't significant, in our case, (p < 0,05). We think that the optimum time for surgical treatment should not be based only on the period of time of conservative treatment, but other factors should be taken on consideration like: the pathology that has indicated the surgical treatment, the number of surgical interventions and period of time between these interventions.

Management of Enterocutaneous Fistula: A Review

“…29 Somatostatin agonists like Octreotide promotes earlier closure of fistula than TPN alone, even with malignant enterocutaneous disease, and is overall helpful in declining secretions in high-output fistulas to a convenient level. 30,31 Proton pump inhibitors or histamine H2 -receptor antagonists decrease gastric acid production, increase the transit time, and lower gastric secretions. These help lessen fistula output, chiefly proximal fistulas or when there are high gastric secretions.…”

“… 29 Somatostatin agonists like Octreotide promotes earlier closure of fistula than TPN alone, even with malignant enterocutaneous disease, and is overall helpful in declining secretions in high-output fistulas to a convenient level. 30 , 31 …”