A novel technique for large lateral enterocutaneous fistula management after intestinal transplantation
Agustina R Oliva1, Paula Violo Gonzalez1, Luciana Lerendegui1
1Department Pediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
A novel nonoperative technique transiently manages high-output pediatric enterocutaneous fistulas (ECF) by redirecting intestinal contents. This approach reduces output and skin damage, serving as a bridge to surgical closure.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Medical device innovation
Background:
- Enterocutaneous fistula (ECF) presents significant challenges in pediatric patients, associated with high morbidity and mortality rates (10-20%).
- Management complexity arises from fistula output volume and distal bowel patency, impacting spontaneous closure rates.
- High-output fistulas and associated skin damage pose considerable clinical challenges.
Background:
Enterocutaneous fistula (ECF) is a serious and complex problem when affecting children, being responsible for a high morbidity burden, with an estimated mortality rate of 10 to 20%. There are many therapeutic options, including surgery and a wide variety of nonoperative strategies. Prognosis of ECF closure depends on the output and also on the patency of distal bowel. Spontaneous closure without operative intervention occurs in approximately 50% of patients with lateral ECF and distal bowel transit, but this drastically decreases in high output fistulas. High-volume fistula output and consequent skin damage are a great challenge for the health-care team.
Methods:
We describe a postoperative complication that required a new nonoperative technique for the transient management of a lateral high-output ECF, involving the insertion of an occlusive device in order to redirect intestinal content to the distal bowel, reducing the fistula output.
Results And Conclusions:
The main benefit of this nonoperative technique is the ability to occlude a high-output fistula, allowing the distal flow to be restored and reducing abdominal wall damage, as a bridge to definitive surgical closure.
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