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A Journal on Surgery

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Chirurgia 2013 August;26(4):333-5


language: English, Italian

Definitive enterocutaneous fistula as complication of actinic enteritis

Quarto G., Bucci L., Solimeno G., Furino E., Benassai G. L., Sivero L., Benassai G.

Department of General, Geriatric, Oncological Surgery and Advanced Technologies, Federico II University, Naples, Italy


Enterocutaneous fistula (ECF) is a serious complication of the surgery of the digestive tract. The management of an ECF is multidisciplinary. This condition leads the patient to a profound state of cachexia and it causes often fatal complications. Nowadays, mortality has fallen to about 20%. Therapy can be medical or surgical, but surgery become mandatory according to FRIEND criteria. We present a case of a 62-year-old female patient, suffering from enterocutaneous fistula following surgery for bowel obstruction due to actinic enteritis subsequent to adjuvant radiotherapy for cervix cancer. The patient came to the observation of Department of General, Geriatric, Oncological Surgery and Advanced Technologies, Federico II University, as a surgical urgency. The exploratory laparotomy showed a severe actinic enteritis with the presence of retroperitoneal fibrosis; pelvis was “frozen” with ileal loops firmly adherent each other and this forced the operator not to perform any external ileal derivation. Ten days after surgery, the abdominal median wound revealed frankly enteric material. CT showed the presence of an high-flow enterocutaneous fistula in proximal ileum. It was decided that the re-intervention was not a viable option. So the management of the EFC was medical. The EFC was brought to the surface and placed under vacuum. About three months from its appearance, there was formation of a sort of total high ileal derivation. So vacuum has been suspended and an ileostomy bag has been placed. This result is to be considered absolutely favorable.

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