Continuous irrigation and suction with a triple-cavity drainage tube in combination with sequential somatostatin-somatotropin administration for the management of postoperative high-output enterocutaneous fistulas: Three case reports and literature review

Abstract

Introduction: Enterocutaneous fistula is considered one of the most serious complications in general surgery and is associated with high morbidity and mortality. Although various treatments are reported to have varying success, high-output enterocutaneous fistulas (output over 500 ml/day) continue to be associated with high mortality, and few papers on this topic exist in the literature. The aim of this study is to describe an effective multidisciplinary treatment method for postoperative high-output enterocutaneous fistula and discuss the clinical development of the therapeutic strategy.

Patient concerns: Three patients suffered high-output enterocutaneous fistulas, in which case 1 presented with duodenal fistula, case 2 with ileal fistula, and case 3 with small bowel fistula.

Diagnosis: All 3 cases were diagnosed with high-output enterocutaneous fistulas by drainage of intestinal contents.

Interventions: With the exception of routine treatment including fluid resuscitation, correction of the electrolyte balance, control of infection, and optimal nutrition, all the cases accepted continuous irrigation and suction with triple-cavity drainage tubes in combination with sequential somatostatin-somatotropin administration were given. With regard to establishing effective drainage, the triple-cavity tube placement was performed by insertion through the initial drainage channel in case 1, percutaneous puncture with dilation by graduated dilators in case 2, and tract reconstruction in case 3. The technical details of the approach are described and clinical characteristics including fistula location, defect size, output volume, approach of triple-cavity tube placement, length of fistula tract, somatostatin and somatotropin administration time, and fistula healing time were recorded and compared. In addition, other various techniques reported in the literature are reviewed and discussed.

Outcomes: All the patients were cured by the multidisciplinary treatments and were followed up without fistula recurrence and other relevant complications at 1 week, 1 month, and 3 months after the treatments.

Conclusion: The strategy involving continuous irrigation and suction with a triple-cavity drainage tube in combination with sequential somatostatin-somatotropin administration may be a safe and effective alternative treatment for postoperative high-output enterocutaneous fistula and a more practical method that is easy to execute to manage this problem. Long-term studies, involving more patients, are still necessary to confirm this suggestion.

Figure 1

The homemade triple-cavity unit consisted of 3 different tubes: a large-bore silicone tube as an outer sleeve (A) with multiple side holes and 2 fine-bore tubes, including 1 for suction (B) inside the outer sleeve and another for irrigation (C) outside the outer sleeve. The irrigation tube is fixed to the outer sleeve.

Figure 2

A schematic diagram of fistula tract reconstruction. (A) A defect on the small intestine exposed to the air and the re-sutured skin with fistula tract reconstruction. (B) Front view of embedding the triple-cavity tube in subcutaneous tissues. (C) Section view of embedding the tube in subcutaneous tissues.

Figure 3

The flow diagram of postoperative enterocutaneous fistula treatment strategy.