Colocutaneous Fistula Research Articles

Plug and play: vascular plug therapy for refractory colocutaneous fistula

Plug and play: vascular plug therapy for refractory colocutaneous fistula

Profuse diarrhea after percutaneous change of a computed tomography-guided gastrostomy: endoscopic closure of a colocutaneous fistula.

Profuse diarrhea after percutaneous change of a computed tomography-guided gastrostomy: endoscopic closure of a colocutaneous fistula.

SAGA OF A DECADE! BILATERAL GROIN MESH EXPLANTATION WITH COLOCUTANEOUS FISTULA

Abstract Background Mesh-related complications following previous laparoscopic hernia repair, especially transabdominal preperitoneal (TAPP) surgery, can present significant challenges. This case report highlights the utilization of the Mesh Explantation Classification in a 60-year-old male with a colocutaneous fistula a decade after index surgery & emphasises the use of mesh explantation classification for standardisation & case reporting (Published in Hernia Surgery). Objective Describe the laparoscopic mesh explantation and stapled disconnection of a colocutaneous fistula in a patient with mesh-related complications post-TAPP surgery 10 years back and emphasize the mitigation strategies and technical nuances. Methods A 60-year-old male, previously subjected to TAPP surgery, presented with a colocutaneous fistula with faecal discharge secondary to mesh-related complications. Pre-operative colonoscopy, marking the site of the fistula and use of fluoroscopy for identification of any metal tacks were performed. The Laparoscopic mesh explantation and the disconnection of the colocutaneous fistula using an intestinal stapler and intraoperative sigmoidoscopy performed to avoid any luminal narrowing. Two pieces of polyester mesh, with metal tackers were successfully explanted without any collateral vascular injury. Results The patient experienced resolution of symptoms postoperatively, and there were no signs of recurrent fistula during follow-up; the explanted mesh showed features of atypical mycobacterium on the microbiology, and hence, the patient was put on one year of treatment for atypical mycobacterium, he tolerated the treatment well and recovered. Conclusion This case emphasises the importance of a team approach at Index surgery in every case of Mesh Explantation to get the best surgical outcomes. Mesh explantation standardisation classification helps in proper documentation by the surgeon and guides future additional treatment if required. Further research and collective documentation using standardized classifications are essential to refine and validate the approach for mesh explantation in hernia surgery.

Extracellular matrix enterocutaneous fistula plug placement: An interventional radiology-guided procedure for fistulae refractor y to care

Objective: Enteric fistulas are serious bowel injuries that significantly decrease patient life quality. Operative treatments neglect patients who are not surgical candidates or who have failed surgery. One non-operative method is the percutaneous placement of an extracellular matrix enterocutaneous fistula plug (ECMFP), which sits in the fistula tract and constructs a surface into which the fistula heals. Materials and Methods: This study included ten patients who had an ECMFP placed between June 2017 and July 2022 with follow-up through October 2022. The median patient age was 66.5 years. Fistulae origins were gastrocutaneous (n = 1), enterocutaneous (n = 4), and colocutaneous (n = 5). Results: Of the ten patients, fistula closure was achieved in 5 (50%). Closure occurred in three of four enterocutaneous (75%), one of one gastrocutaneous (100%), and one of five colocutaneous fistulae (20%). The median time to closure was 1 month. Successfully closed fistulae had a mean duration of existence of 4.6 months. Failed closures had a mean duration of existence of 15.3 months. Fistulae originating from a percutaneous enteric tube had success in 2 of 3 patients (66%). Fistulae due to diverticulitis did not achieve closure (0 of 3). Conclusions: ECMFPs are a viable treatment to consider in a patient population that has few other options. They can be useful for the closure of fistulae involving the stomach or small bowel with an existence of <1 year. Patients with fistulae of colonic origin, patients who have had fistulae for longer than 1 year, or patients whose fistulae are due to diverticulitis are less likely to see successful closure.

Increasing Use of Prophylactic Open Abdomen Therapy With Vacuum Assisted Wound Closure and Mesh Mediated Fascial Traction After Repair of Ruptured Abdominal Aortic Aneurysm

Open abdomen therapy (OAT) is commonly used to prevent or treat abdominal compartment syndrome (ACS) in patients with ruptured abdominal aortic aneurysms (rAAAs). This study aimed to evaluate the incidence, treatment, and outcomes of OAT after rAAA from 2006 to 2021. Investigating data on resuscitation fluid, weight gain, and cumulative fluid balance could provide a more systematic approach to determining the timing of safe abdominal closure. This was a single centre observational cohort study. The study included all patients treated for rAAA followed by OAT from October 2006 to December 2021. Seventy-two of the 244 patients who underwent surgery for rAAA received OAT. The mean age was 72 ± 7.85 years, and most were male (n= 61, 85%). The most frequent comorbidities were cardiac disease (n= 31, 43%) and hypertension (n= 31, 43%). Fifty-two patients (72%) received prophylactic OAT, and 20 received OAT for ACS (28%). There was a 25% mortality rate in the prophylactic OAT group compared with the 50% mortality in those who received OAT for ACS (p= .042). The 58 (81%) patients who survived until closure had a median of 12 (interquartile range [IQR] 9, 16.5) days of OAT and 5 (IQR 4, 7) dressing changes. There was one case of colocutaneous fistula and two cases of graft infection. All 58 patients underwent successful abdominal closure, with 55 (95%) undergoing delayed primary closure. In hospital survival was 85%. Treatment trends over time showed the increased use of prophylactic OAT (p ≤ .001) and fewer ACS cases (p= .03) assessed by Fisher's exact test. In multivariable regression analysis fluid overload and weight reduction predicted 26% of variability in time to closure. Prophylactic OAT after rAAA can be performed safely, with a high rate of delayed primary closure even after long term treatment.

1036 Colonic Erosion of a Laparoscopically Inserted Adjustable Gastric Band

Abstract The popularity of laparoscopic adjustable gastric band surgery has declined over the past decade. This is partly due to concerns about a high rate of long-term complications, including band erosions occurring in over 1% of cases. Erosion into the colon is exceedingly rare, with only three reports in the literature. Our images/video illustrate the case of a 51-year-old female patient presenting in February 2022 with abdominal pain and two chronically discharging sinuses around her port site. She had a gastric band initially fitted in 2010, which was revised in 2018. The port was re-sited in 2021 following port-migration and flipping. On this presentation, a CT scan revealed 16cm of tubing within the lumen of the descending colon. Our procedure began with diagnostic laparoscopy, showing the gastric band tubing entering an inflammatory phlegmon in the left flank involving omentum and descending colon attached to the abdominal wall beneath the port site. The tubing was cut near to the gastric band. The gastric band was freed, divided, and removed. The previous port site incision was extended around the external opening of the fistula, which was excised. The port and tubing were easily removed, though partly covered in faeces. A decision was made, based upon prior discussion with the patient, to leave the colocutaneous fistula in-tact. This avoided the risk of colonic resection and anastomosis in freeing the bowel. Stapling across the phlegmon and tract risked diverting colonic contents into another potential tract headed towards the stomach. Postoperative recovery was uneventful.

Spontaneous closure of transverse loop colostomy: A case report

Colostomy is an artificial colo-cutaneous fistula which can be temporary or permanent, depending on the purpose for which it was created. The indications for colostomy include protection of a distal intestinal anastomosis, control of sepsis in open injury to the colon or rectum, to facilitate the operative treatment of a high anal fistula

Colocutaneous fistula with recurrent urinary tract infection: a delayed complication following laparoscopic transabdominal pre-peritoneal repair

There has been an increase in incidence of delayed complications following transabdominal pre-peritoneal repair (TAPP) for inguinal hernia in the last two decades. Mesh related visceral complications (MRVCs) are difficult to diagnose and treat. Colocutaneous and colovesical fistualas are rare yet devastating delayed complications caused by mesh migration. We present the case of a 40-year-old man who presented to us after numerous hospital visits with urinary symptoms and a recurring fistula on the left abdominal wall at a previously operated site. Computed tomography revealed an ill-defined collection in left loin region abutting the sigmoid colon and urinary bladder. Owing to acute angulation, the colonoscope could not be passed beyond 30 cm. The patient was managed with cystoscopy, laparotomy, mesh explantation, and sigmoid colon resection.

Occurrence of Retrorenal Colon in the Indian Population – A Significant Finding from Urological Perspective

Introduction: Ascending and descending coli normally are located anterolateral to kidneys. Retrorenal position of the colon has a reported prevalence of 10%–20% in the general population. Its occurrence is of significant while performing percutaneous nephrolithotomy (PNL) which is a routine management procedure for patients showing clinical disease associated with renal calculus. PNL in patients with retrorenal colon can lead to colonic perforation which is associated with significant morbidity and mortality related to septicemia, peritonitis, formation of abscess, and nephro-colic and/or colo-cutaneous fistulae. Hence, the preoperative information about the presence of retrorenal colon is essential for the prevention of surgical complications. Materials and Methods: Our retrospective study included patients who underwent computed tomography (CT)/magnetic resonance (MR) abdomen in our department of radiodiagnosis. All the scans were evaluated for the presence of retrorenal colon. The persistence of retrorenal colon was also observed with change in posture among those with prone scans. Results: The retrorenal colon was present in 130 out of 669 patients included in the study, with an occurrence rate of nearly 20%. Alteration in the position of retrorenal colon was noted with prone position in approximately 79%. Conclusion: The occurrence of retrorenal colon is high in the Indian population being approximately 20% without change with prone position in one-fifth. Thus, to reduce the risk of complication related to colonic perforation during PNL, all patients must be subjected to CT/MR abdomen to detect retrorenal colon followed by scan in the prone position, if retrorenal colon is present, to evaluate the alterations in colonic position with prone posture.

Spontaneous Bilateral Lumbar Region Colocutaneous Fistulae. A Case Report

Bilateral spontaneous lumbar colocutaneous fistulae are rare. They are associated with high costs of care, morbidity, and mortality. We present the case of a 50- year-old male patient who presented with a 10-year history of two low-output spontaneous colocutaneous fistulae from both the left and right lower lumbar regions with no identifiable risk factors. He was managed operatively with segmental left colon resection and a temporary loop ileostomy with uneventful recovery after reversal of the ileostomy 2 months later. Whether the etiology of the fistulae is clinically apparent or not, the management should follow commonly known principles. This report highlights a case of bilateral lumbar region spontaneous colocutaneous fistulae of unknown cause that was managed operatively with satisfactory short-term outcomes.

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Symptoms: Abdominal Pain, Diaphoresis, Fever, Nausea, and Constipation

Successful Endoscopic Closure of the Appendiceal Orifice

Introduction: Colocutaneous fistulas are severe complications that traditionally are repaired surgically with resection of the fistula followed by end-to-end anastomosis of the bowel. Given the high morbidity of surgery, an alternative approach to consider is endoscopic fistula closure with clips, which is a minimally invasive approach and is safe with high success rates.1–5 Currently, there are no reports in the literature describing endoscopic closure of the appendiceal orifice. This video case report describes a technique for placement of an over the endoscope clip at the appendiceal orifice to effectively close a colocutaneous fistula. Materials and Methods: The patient was a 69-year-old male with Marfan's syndrome who was 5 months status post primary repair of a duodenal perforation with feculent peritonitis. His early postoperative course was complicated by a persistent leak from an unknown source. One month postoperatively, imaging showed a large retroperitoneal abscess that required percutaneous drain placement. At that time, surgical endoscopy was consulted for duodenal evaluation and found no clear evidence of a leak from the duodenum. A percutaneous endoscopic gastrostomy tube with a jejunal feeding extension was placed. Four months after his index operation, he presented to the clinic with a change in drain output character that was suspicious for an enterocutaneous fistula. Fistulogram with contrast injected into the patient's percutaneous drainage catheter demonstrated continuity with the colon in the right lower quadrant. He was taken for a colonoscopy and fluoroscopy for further evaluation of the colocutaneous fistula. After injection of saline at the drain site, saline was seen trickling into the cecum from the appendiceal orifice. The decision was made to close the orifice with a 12/6T over-the-endoscope clip. The percutaneous retroperitoneal drain was removed 5 days postoperatively and he was discharged home 7 days postoperatively on a low residue diet. Results: At 1 month follow-up, the patient was doing well on a regular diet with no abdominal pain or fevers. A routine imaging scan performed 7 weeks postoperatively showed no recurrent retroperitoneal fluid collection. His gastrojejunal feeding tube was removed. Conclusion: Over-the-endoscope clipping of the appendiceal orifice to repair a colocutaneous fistula is technically feasible and appears safe. Endoscopic therapy spared this patient from a potential ileocecectomy. To date, no other similar procedures have been performed by our department in other patients. Further study is necessary to establish the safety of this procedure before its implementation as standard practice. A.H. has no disclosures. E.M.P. is a lecturer for BD, Medtronic, Ovesco, and Boston Scientific. E.M.P. is a consultant for Boston Scientific, Actuated Biomedical, Baxter, Wells Fargo, Cook Biotech, Neptune Medical, Surgimatrix, CMR Surgical, Boehringer Laboratories, Allergan, and Noah Medical. J.S.W. is a consultant for Boston Scientific. Author(s) have received and archived patient consent for video recording/publication in advance of video recording of procedure. Runtime of video: 5 mins 20 secs This video was accepted as a video presentation at the 2023 Society of Gastrointestinal and Endoscopic Surgery on March 29 to April 1, 2023.

WEO Newsletter.

WEO Newsletter.

Left thigh necrotizing fasciitis secondary to colocutaneous fistula in previously treated rectal cancer: case report of a single, late and fatal complication

Left thigh necrotizing fasciitis secondary to colocutaneous fistula in previously treated rectal cancer: case report of a single, late and fatal complication

Tailored chemotherapy for colorectal cancer peritoneal metastases based on a drug-screening platform in patient-derived organoids: a case report.

Peritoneal metastasis from colorectal cancer (CRC) has limited therapeutic options and poor prognosis. Systemic chemotherapy combined with cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) or pressurized intraperitoneal aerosol chemotherapy (PIPAC) have yielded initial promising results. However, standard local therapies with oxaliplatin and mitomycin are not optimal and a better individualized management of these patients remains as an unmet clinical need. Patient-derived organoid (PDO) technology allows to culture in three dimensions normal and cancer stem cells (CSC) that self-organize in multicellular structures that recapitulates some of the features of the particular organ or tumor of origin, emerging as a promising tool for drug-testing and precision medicine. This technology could improve the efficacy of systemic and intraperitoneal chemotherapy and avoid unnecessary treatments and side effects to the patient. Here we report a case of a 45-year-old man with a rectal adenocarcinoma with liver, lymph node and peritoneal metastases. The patient was treated with systemic chemotherapy (FOLFOXIRI plus Bevacizumab) and was subjected to mitomycin-based PIPAC. We generated patient-derived peritoneal carcinomatosis organoids in order to screen the activity of drugs for a personalized treatment. Both 5-FU and SN-38, the active irinotecan derivative, displayed strong cytotoxicity, while the response to oxaliplatin was much lower. Although the development of a colo-cutaneous fistulae prevented from further PIPAC, the patient continued with fluoropirimidine maintenance treatment based on standard clinical practice and the drug-screening test performed on organoids. Our results suggest that the peritoneal implant shows chemoresistance to oxaliplatin, while it might still be sensitive to irinotecan and 5-FU, which supports a potential benefit of these two drugs in the local and/or systemic treatment of our patient. This study shows the strength of the utility of the establishment of organoids for drug response assays and thus, for the personalized treatment of colorectal carcinomatosis patients.

Management of Colocutaneous Fistula with Surgical Intervention: A Case Report

A colocutaneous fistula is a type of enterocutaneous fistula where communication exists between the colon and the skin of the abdominal wall. The present case report was of postoperative colocutaneous fistula in a 32-year-old male patient, who had undergone left open nephrectomy. This is unique, as nephrectomy is not a procedure that is usually associated with such colocutaneous fistulas, particularly as this was a case of non functioning kidney and was not associated with severe inflammation or adhesions, which are usually prerequisites for a fistula to arise. Following surgery, patient developed feculent discharge from the drain in the early postoperative period. A Contrast Enhanced Computed Tomography (CECT) scan for evaluation of the cause of leak was done, which showed a colocutaneous fistula arising from the proximal descending colon with an abscess surrounding the fistula tract. The abscess was drained and conservative management was initially attempted to allow for spontaneous resolution of the fistula as spontaneous closure is the norm, when there are no unfavourable factors hindering spontaneous closure, as was the case in this patient. However, despite all factors being favourable for spontaneous closure of the fistula, it failed to occur in the present case. Furthermore, this patient required multiple surgical procedures, which is also unusual for a fistula such as this, where all factors being favourable for its spontaneous healing. Closure of the fistula was finally being achieved by resection of the fistula tract along with the segment of the bowel containing the internal opening. The present case report highlighted the challenges posed by cases of colocutaneous fistulas and shows that thorough knowledge of all the treatment modalities available for its treatment, is required to successfully treat it.

A Novel Negative Pressure Therapy Technique to Manage a Colo-Cutaneous Fistula following Emergency Aortic Surgery

Negative pressure wound therapy (NPWT) is a well-established technique for managing the open abdominal wound. The decision to intentionally leave an abdominal incision open may be required in the aftermath of surgery for intra-abdominal sepsis or where there is concern regarding abdominal compartment syndrome (ACS). Untreated ACS following elective, or emergency abdominal aortic aneurysm repair (AAA) is associated with mortality rates of up to 60% [1]. Management of the open abdomen, particularly in obese patient, is challenging and labour-intensive. The aim of wound management in this setting is to contain drainage, manage the peri-wound skin and facilitate closure of the wound. This case report discusses the successful management of a complex abdominal wound in a morbidly obese patient complicated by a colo-cutaneous fistula following emergency abdominal aortic aneurysm repair.

Percutaneous Endoscopic Gastrostomy Infection: 10% Povidone Iodine Miracle

Gastrostomy is the procedure of inserting a tube through the abdominal wall into the stomach in order to provide nutrition in cases where gastrointestinal system functions are normal but oral intake is not sufficient and enteral nutrition is predicted to take more than 4-6 weeks. Gastrostomy was first introduced in 1980. Although minor complications such as peristomal infection and infiltration, pneumoperitoneum, gastrointestinal bleeding and ulceration may be seen due to gastrostomy; Major complications such as necrotizing fasciitis, colocutaneous fistula and aspiration may also occur. In the literature, 1–4% minor and 8–30% important results related to gastrostomy are reported. Peristomal, which is one of the gastrostomy minor examinations, can already be treated with close and good care. In our case report, infections that may occur at the gastrostomy insertion site were reported, possible causes were discussed, a case with a diagnosed with peristomal infection and treated with povidone iodine solution (baticone/betadine) was presented, and the literature on the subject was compiled.

S2042 Hydronephrosis: An Unusual Complication of Diverticular Abscess

Introduction: Acute diverticulitis is inflammation due to microperforation of diverticulum in the colon. Ureteral complications from inflammatory bowel disease and colon cancer have been extensively documented, however, hydronephrosis as a complication of diverticulitis is rarely reported. We present a case of a patient with a diverticular abscess who developed left-sided hydronephrosis. Case Description/Methods: A 40-year-old man with a past medical history of laparoscopic cholecystectomy presented with left lower quadrant cramping abdominal pain for 2 weeks. He endorsed constipation for 3 months but denied other symptoms. His physical examination was significant for a palpable phlegmon in the left lower quadrant with mild tenderness to palpation. Laboratory values revealed hemoglobin of 11.4 g/dl, platelet count of 499 k/ul and unremarkable basic metabolic panel. Computed tomography (CT) scan of the abdomen with contrast revealed severe sigmoid diverticulitis and perisigmoid abscess measuring 6 x 2.6 cm (Figure A). It further revealed moderate left hydronephrosis with narrowing of the ureter, concerning for external ureteral compression by the diverticular abscess (Figure B). After multidisciplinary discussion with interventional radiology, urology, and surgery, recommendation was made to undergo surgical intervention after the resolution of acute diverticulitis. The patient was treated with intravenous antibiotics with symptomatic relief and discharged with plan for outpatient surgery. The patient was unfortunately lost to follow-up. He presented 3 months later with perforated diverticulitis, persistent hydronephrosis, colovesical and colocutaneous fistula requiring exploratory laparotomy and repair. His surgical pathology was negative for malignancy and revealed severe diverticulitis. Patient was discharged home in stable condition. Discussion: Ureteral complications in diverticulitis can occur due to the close anatomical location of the left ureter to the descending and sigmoid colon. Common urologic complications include the development of enterovesical fistulas and urinary calculi and obstruction. Physicians should be aware of this association to ensure a repeat CT scan is performed 4-6 weeks after acute diverticulitis to document resolution. Figure 1.: A. CT scan of the abdomen revealing 60.1 x 26.3 mm diverticular abscess. B. CT scan of the abdomen showing left hydronephrosis and dilation of the ureter.

Colorectal carcinoma presenting as spontaneous colocutaneous fistula - A rare case report and review of literature.

Introduction and importanceColon cancer presenting as spontaneous enterocutaneous fistula are rare with only few cases reported in the literature. Such presentation signifies locally advanced disease with poorer outcomes. Enterocutaneous fistula increases morbidity and mortality in cancer and may potentially delay the definitive care. It poses a difficulty in management in terms of patient optimization, determining the type of resection (palliative or curative) and the operative timeline.Case presentationA 47 years old female presented with complaints of foul smelling discharge from a fistulous opening in right iliac fossa with occasional per rectal bleeding for the past six months. Imaging showed ascending colon mass breaching the peritoneum with fistulous tract opening into subcutaneous plane. Exploratory laparotomy with extended right hemicolectomy and en bloc resection was performed.Clinical discussionCutaneous fistula can be caused by traumatic, postoperative etiologies and about 20 % are of spontaneous etiologies. Colon cancer has the ability to mimic any abdominal disease with a wide spectrum of presentations. The locoregional extension from the bowel creates a passage of colonic contents to evacuate from the external opening. The fistulous tract of colon cancer is less likely to close spontaneously and may require surgical intervention following appropriate resuscitation. Due to features suggestive of bowel obstruction an early single stage surgery was performed in our case.ConclusionThere are no existing guidelines for colon cancer with colocutaneous fistula because they are the same for benign fistulas (resuscitation, control of output, eradication of the infection, nutritional optimization, surgery) along with a multidisciplinary oncology team approach.