Barreto Isabel, Kohler Arnold, Fahrner René
Department of Surgery, Bürgerspital Solothurn, CH-4500 Solothurn, Switzerland.
Department of Surgery, University Hospital Zürich, University of Zürich, Zürich, Switzerland.
Innov Surg Sci. 2024 Apr 9;9(2):109-112. doi: 10.1515/iss-2023-0051. eCollection 2024 Jun.
Fistula formation between the duodenum and the skin of the anterior abdominal wall is a rare complication and reported most often following surgery. To the best of our knowledge, the development of a spontaneous duodenocutaneous fistula in association with duodenal ulcer has only been reported once.
A 52-year-old female patient presented at the emergency department with a painful ulcer and erythema on the right abdominal wall. On admission, she was in extremely poor general and nutritional condition. Laboratory analysis revealed inflammation. An empiric antibiotic therapy was initiated; parenteral nutrition, fluid, and electrolyte resuscitation were started. An enterocutaneous fistula was postulated and confirmed by endoscopy identifying a perforated duodenal ulcer. Surgery was not a valuable option and a Foley catheter was inserted through the fistula. During further endoscopic interventions, the Foley catheter was first replaced by a jejunal tube and later by a percutaneous endoscopic gastrostomy with a jejunal limb for enteral nutrition. The fistula output decreased, the local infection was controlled and the nutritional status improved.
Three months later the fistula was closed and the gastrostomy tube was removed. After 2 years the patient was in good general and nutritional condition.
十二指肠与前腹壁皮肤之间形成瘘管是一种罕见的并发症，最常于手术后报道。据我们所知，与十二指肠溃疡相关的自发性十二指肠皮肤瘘仅被报道过一次。
一名52岁女性患者因右腹壁疼痛性溃疡和红斑就诊于急诊科。入院时，她的全身和营养状况极差。实验室分析显示有炎症。开始经验性抗生素治疗；同时开始肠外营养、补液及电解质复苏。推测存在肠皮肤瘘，并经内镜检查证实为十二指肠溃疡穿孔。手术并非可行选择，遂经瘘管插入一根 Foley 导管。在进一步的内镜干预过程中，Foley 导管先被空肠管取代，之后又被带有空肠袢的经皮内镜下胃造瘘术取代以进行肠内营养。瘘管排出量减少，局部感染得到控制，营养状况改善。
三个月后瘘管闭合，胃造瘘管拔除。两年后患者全身及营养状况良好。
