Musa N, Aquilino F, Panzera P, Martines G
G Chir. 2017 Sep-Oct;38(5):256-259. doi: 10.11138/gchir/2017.38.5.256.
Enterocutaneous (EC) fistula is an abnormal communication between the gastrointestinal tract and the skin. The majority of EC fistulas result from surgery. Only 15-25% of EC fistulas are spontaneous and they often result from underlying diseases such as Crohn's disease, radiation and chemotherapy.
A 62-year old woman who, in 2012, underwent Pylorus-preserving cephalic pancreaticoduodenectomy (PPPD sec. Traverso-Longmire), due to an advanced pancreatic ductal adenocarcinoma (pT3N1M1). After surgery, the patient underwent chemotherapy with folfirinox regimen. In December 2016, as a result of the appearance of metastatic liver lesions and perianastomotic recurrence, the patient underwent second line treatment with Gemcitabine and pab-paclitaxel. After five months from the beginning of this new second line therapy she presented an EC fistula. The fistula of the patient was successfully treated with total parenteral nutrition and with percutaneous injection of cyanoacrylic sealant.
The result suggests the advisability of percutaneous injection of sealant devices, such as cyanoacrylate glue; in order to successfully control stable Enterocutaneous fistulas with acceptable morbidity and mortality especially in particular situations, such as, with low output EC fistulas without signs of complications or on patients considered not suitable for surgery, a conservative approach could ensure the control of the fistula.
This approach is easy and safe, viable and useful for future trials on the efficacy in conservative treatment of EC fistula.
肠皮肤瘘是胃肠道与皮肤之间的异常通道。大多数肠皮肤瘘由手术引起。只有15%-25%的肠皮肤瘘是自发性的，通常由克罗恩病、放疗和化疗等基础疾病导致。
一名62岁女性，2012年因进展期胰腺导管腺癌（pT3N1M1）接受了保留幽门的胰头十二指肠切除术（特拉弗索-朗迈尔法）。术后，患者接受了FOLFIRINOX方案化疗。2016年12月，由于出现肝转移灶和吻合口周围复发，患者接受了吉西他滨和白蛋白结合型紫杉醇的二线治疗。在开始这种新的二线治疗五个月后，她出现了肠皮肤瘘。该患者的瘘通过全胃肠外营养和经皮注射氰基丙烯酸酯封闭剂成功治愈。
结果表明，经皮注射封闭剂装置（如氰基丙烯酸酯胶）是可取的；为了成功控制稳定的肠皮肤瘘，尤其是在特定情况下，如低流量且无并发症迹象的肠皮肤瘘或被认为不适合手术的患者，采用保守方法可确保控制瘘。
这种方法简便、安全、可行，对未来肠皮肤瘘保守治疗疗效的试验有用。
