Two Cases of Enterocutaneous Fistula Treated with Over-The-Scope Clip (OTSC) due to Anastomotic Leakage after Sigmoidectomy for Diverculitis

Abstract

We report two cases of treatment with over-the-scope-clip (OTSC) for anastomotic leakage after sigmoid colectomy for diverticulitis. Case 1 was a 52-year-old man who visited the hospital with lower abdominal pain and hematochezia and was diagnosed with sigmoid colon diverticulitis and mesenteric penetration by contrast CT. Sigmoid colectomy (end-to-side anastomosis) and diverting ileostomy were performed. On postoperative day 46, enterocutaneous fistula due to anastomotic leakage was diagnosed by fistulography and fistula closure using OTSC treatment was performed on postoperative day 121. After treatment of OTSC closure, the enterocutaneous fistula healed and the ileostomy was closed.

Case 2 was a 56-year-old man who visited the hospital with pneumatourea and was diagnosed with sigmoidvesical fistula by contrast CT. Sigmoid colectomy (end-to-side anastomosis) and diverting transverse colostomy were performed. The relapsing-remitting clinical course of SSI was observed repeatedly and enterocutaneous fistula due to anastomotic leakage was diagnosed with fistulography on postoperative day 221. Although we tried to use this OTSC approach for refractory fistula closure five times, we failed to close it and finally performed a surgical fistulectomy.