TWO CASES OF INTRACTABLE ENTERO-CUTANEOUS FISTULAS TREATED BY THE LOCAL CUTANEOUS FLAP METHOD

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  • 難治性小腸皮膚瘻に対する皮弁形成瘻孔閉鎖術の２例

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We report two cases of intractable entero-cutaneous fistulas successfully treated by the local cutaneous flap method. As for operative procedures in these cases, skin incision was made around the fistula under general anesthesia. Debridement of the scarred tissues was done. The fistula was closed tightly with the cutaneous tissues around the fistula by 3-0 absorbable interrupted sutures. This skin defect was covered with a cutaneous flap. Patient 1 had undergone chemotherapy and radiation therapy at 40Gy after an operation for seminoma of the testis 10 years before admission. Recently, an entero-cutaneous fistula induced by radiation therapy appeared at the surgical scar. The local cutaneous flap method was performed. Oral intake was started 3 weeks after this method. Patient 2 had undergone subtotal colectomy with ileostomy for toxic amebic colitis. An intractable entero-cutaneous fistula was formed after the second operation done for peritonitis due to small intestinal perforation 9 days after the first operation. The fistula could not be cured with conservative therapy for 11 months. The local cutaneous flap method was thus performed. Although leakage of intestinal juice occurred 3 weeks after the method, the fistula was cured 3 months after this method. It is considered that the method should be tried for intractable entero-cutaneous fistula.

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