A case report of intractable enterocutaneous fistula after ileocecotomy treated with endoscopic injection of histoacryl

Abstract

A 65-year-old man who had undergone ileocecotomy for ascending colon cancer in August 2006 developed anastomotic leakage on the 4th postoperative day. He underwent reoperation, including resection of the anastomotic site and re-ileocolotomy. On the 16^th postoperative day, an abdominal CT scan revealed an intraabdominal abscess around the anastomotic site, which required 3^rd operation consisted of washing and drainage. Soon after the beginning of meal, succus entericus had leaked from the wound and drain. Despite long-term fasting and washing through a drain for 4 weeks, intractable enterocutaneous fistula was formed. We tried administration of human plasma coagulation factor XIII for five days and injection of fibrin glue three times every seven days, but the fistula still opened. Accordingly we tried endoscopic injection of histoacryl, and eventually succeeded to close the fistula. Because this method is simple, visible and easy, it might be one of the useful therapies to treat intractable enterocutaneous fistulae.