Details

Autor(en) / Beteiligte

• Cambj Sapunar, Liana
• Sekovski, Budimir
• Matić, Dario
• Tripković, Andro
• Grandić, Leo
• Družijanić, Nikica

Titel

Percutaneous embolization of persistent low-output enterocutaneous fistulas

Ist Teil von

• European radiology, 2012-09, Vol.22 (9), p.1991-1997

Ort / Verlag

Berlin/Heidelberg: Springer-Verlag

Erscheinungsjahr

2012

Quelle

MEDLINE

Beschreibungen/Notizen

• Objectives To present and retrospectively evaluate the technique of percutaneous embolization of chronic enterocutaneous fistulas (ECFs) using n -butyl-2-cyanoacrylate and Lipiodol under fluoroscopic guidance. Methods Six patients with a total of seven post-operative low-output ECFs of the large intestine were treated. After fistulography a hydrophilic guide wire and a catheter were advanced through the ECF into the intestine. After dilation of the bowel with saline and contrast medium, the catheter was withdrawn into the enteric orifice and glue together with Lipiodol was injected while simultaneously pulling the catheter. Results Complete closure of all seven fistulas was achieved. There were no peri-procedural complications. In one patient 1 month following embolization a low-output enteric discharge was observed, but the ECF spontaneously healed 5 days later. In one patient 18 months after the embolization a new perforation due to diverticulitis close to the embolization site occurred and resection of the sigmoid colon was performed. One patient needed reoperation due to a recurrence of rectal carcinoma. Conclusions In our series of patients, the presented technique of percutaneous embolization proved to be efficacious and easy to perform. It may have potential as a first-line treatment of low-output ECFs but a prospective study with a larger series of patients and a longer follow-up is required. Key Points • Patients with low-output fistulas have recurrent infections and reduced quality of life. • Surgical treatment is complex with a relatively high morbidity and occasional mortality. • Several percutaneous and endoscopy treatments have previously been proposed with mixed results. • Hydrophilic guide wires and hydrophilic catheters offer new potential treatment options. • Sealing the fistula with cyanoacrylate glue and Lipiodol seems potentially efficacious.