Digestive System Fistula - A Problem Still Relevant Today

• Authors: Stanisław Głuszek , Maria Korczak , Marta Kot , Jarosław Matykiewicz , Dorota Kozieł
• Languages of publication: EN

Abstracts

EN

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.

Keywords

EN

digestive system fistula; nutritional therapy; postoperative complications

• Publisher: De Gruyter Open
• Journal: Polish Journal of Surgery
• Year: 2011
• Volume: 83
• Issue: 1
• Pages: 32-41

Dates

published

1 - 1 - 2011

online

14 - 3 - 2011

Contributors

author

Stanisław Głuszek

author

Maria Korczak

• Clinical Division of General, Oncological and Endocrinological Surgery Provincial Hospital in Kielce

author

Marta Kot

• Clinical Division of General, Oncological and Endocrinological Surgery Provincial Hospital in Kielce

author

Jarosław Matykiewicz

author

Dorota Kozieł

• Department of Surgery and Surgical Nursing with the Scientific Research Laboratory Faculty of Health Sciences, Jan Kochanowski University of Humanities and Sciences in Kielce

References

• Gutowski P, Butkiewicz J, Cnotliwy M: Przetoki pomiędzy protezą aortalną a jelitem. Pol Przegl Chir 1996; 68: 584-88.
• Kościński T, Sękowska M:. Leczenie chirurgiczne przetok odbytniczo-pochwowych. Pol Przegl Chir 2007; 79: 961-71.
• Rychlewski D, Krawczyk Z, Bednarz W: Przetoki żołądkowo-okrężnicze - postępowanie chirurgiczne. Pol Przegl Chir 2004; 78: 373-82.
• Torres-Garcia A, Arguello J, Balibrea J: Gastrointestinal fistulas: patology and prognosis. Scan J Gastroenterol 1994; 207: 39-41.
• Stachowiak M: Współistnienie dwóch przetok pęcherzykowo-dwunastniczych oraz kamicy dróg żółciowych u chorej bez żółtaczki - opis przypadku. Pol Przegl Chir 2007; 79: 1290-97.
• Saint-Marc O, Tiret E: Surgical management of internal fistulas in Crohn disease. J Am Coll Surg 1996; 183: 97.
• Jałocha W, Łuczak R: Perforacja jelita krętego na na tle gruźliczym. Wiad Lek 1994; 47: 302.
• Meissner W, Szabłoński W, Krokowicz P: Leczenie chirurgiczne chorób zapalnych jelit u dzieci i młodzieży. Pol Przegl Chir 2007; 79: 60-71.
• Singh V, Wadleigh R: Gastrocolic fistula as a complication of colon carcinoma. Acta Oncol 1997; 24: 1085-89.
• Sitges-Serra A, Jaurrieta E, Sitges-Sreus A: Management of postoperatice enterocutaneous fistulas. The roles of parenteral nutrition and surgery. Br J Surg 1982; 69: 147-50.
• Paluszkiewicz P, Pertkiewicz M: Podstawy patofizjologiczne leczenia przetok dwunastnicy. Postępy Żywienia Klinicznego 2008; 1: 32-35.
• Foster II CE, Lefor AT: General management of gastrointestinal fistulas. Surg Clin North Am 1996; 76: 1019.[Crossref]
• Friess H, Malferheiner P, Isenmann K: The risk of pancreatointestinal anastomosis can be predicted preoperatively. Pancreas 1996; 12: 202.
• Szczepanik A, Jaśkowiak W, Huszcza S: Leczenie przetok jelitowych przy zastosowaniu całkowitego odżywiania pozajelitowego i somatostatyny. Pol Przegl Chir 2005; 77: 1323-1331.
• Alivzatos V, Felekis D, Zorbalas A: Evaluation of the effectiveness of octreotide In the conservative treatment of postoperative enterocutaneous fistulas. Hepatogastroenterology 2002; 49: 1010-12.
• Głuszek S, Kot M, Matykiewicz J: Przetoki przewodu pokarmowego. Pol Przegl Chir 1999; 71: 40-49.
• Głuszek S, Kot M, Matykiewicz J: Problemy kliniczne rozszerzonych zabiegów resekcyjnych jelit. Wiad Lek 2003; 56: 1-5.
• Ysebaert D, Van Hee G, Hubens W: Management of digestive fistulasd Scand. J Gastroenterol 1994; 29: Suppl. 207.
• Szawłowski A, Pertkiewicz M, Drews M i wsp: Rekomendacje Towarzystwa Chirurgów Polskich i Polskiego Towarzystwa Chirurgii Onkologicznej. Przetoki układu pokarmowego u chorych leczonych z powodu nowotworów - diagnostyka i leczenie. Pol Przegl Chir 2008; 80: 1267-97.
• Yong Sik Yoon, Chang Sik Yu, Suk-Kyun Yang et al.: Intra-abdominal Fistulas in Surgically Treated Crohn's Disease Patients. World J Surg 2010; Published online 7 april[WoS]
• Brenner M, Clayton JL, Tillou A et al.: Risk factors for recurrence after repair of enterocutaneous fistula. Arch Surg 2009; 144: 500-05.[WoS]
• Colombel J-F, Schwartz DA, Sandborn WJ et al.: Adalimumab for the treatment of fistulas in patients with Crohn's disease. Gut 2009; 58: 940-48.[WoS]
• Kountouras J, Zavos C: Recent advances in the management of radiation colitis. World J Gastroenterol 2008; 14: 7289-7301.[Crossref][WoS][PubMed]
• Schwartz DA, Pemberton JH, Sandborn WJ: Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med 2001; 135: 906-18.
• Schwartz DA, Loftus EV, Jr, Tremaine WJ, et al.: The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota. Gastroenterology 2002; 122: 875-80.
• Lapidus A, Bernell O, Hellers G et al.: Clinical course of colorectal Crohn's disease: a 35-year follow-up study of 507 patients. Gastroenterology 1998; 114: 1151-60.
• Sands BE, Anderson FH, Bernstein CN et al.: Infliximab maintenance therapy for fistulizing Crohn's disease. N Engl J Med 2004; 350: 876-85.
• Becker HP, Willms A, Schwab R: Small bowel fistulas and the open abdomen. Scand J Surg 2007; 96: 263-71.
• Bradley EL, Dexter ND: Management of severe acute pancreatitis. A surgical odyssey. Ann Surg 2010; 251: 6-17.
• Andresen DK, Frey ChF: The evolution of the surgical treatment of chronic pancreatitis. Ann Surg 2010; 251: 18-32.
• Gui J, Wang L: Anastomotic leakage mid- low rectal cancer patients following pre- radiated and total mesorectum excision. Ann Oncol 2008; 19 i 24.

Identifiers

DOI

10.2478/v10035-011-0005-9