Successful Management with Cyanoacrylate for an Intractable Enterocutaneous Fistula after Pharyngo-laryngo-esophagectomy for Esophageal Cancer—A Case Report—

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  • WAKE Hitomi
    Department of Digestive and General Surgery, Shimane University Faculty of Medicine
  • MATUBARA Takeshi
    Department of Digestive and General Surgery, Shimane University Faculty of Medicine
  • HIRAHARA Noriyuki
    Department of Digestive and General Surgery, Shimane University Faculty of Medicine
  • HYAKUDOMI Ryoji
    Department of Digestive and General Surgery, Shimane University Faculty of Medicine
  • KIDANI Akihiko
    Department of Digestive and General Surgery, Shimane University Faculty of Medicine
  • TAJIMA Yoshitugu
    Department of Digestive and General Surgery, Shimane University Faculty of Medicine

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Other Title
  • Octyl-2-cyanoacrylateにて閉鎖した食道癌術後の難治性腸管皮膚瘻の1例
  • 症例 Octyl-2-cyanoacrylateにて閉鎖した食道癌術後の難治性腸管皮膚瘻の1例
  • ショウレイ Octyl-2-cyanoacrylate ニテ ヘイサ シタ ショクドウ ガン ジュツゴ ノ ナンチセイ チョウカン ヒフロウ ノ 1レイ
  • Successful Management with Cyanoacrylate for an Intractable Enterocutaneous Fistula after Pharyngo-laryngo-esophagectomy for Esophageal Cancer^|^mdash;A Case Report^|^mdash;

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Abstract

The case involved a man in his seventies who had a history of receiving endolaryngeal microsurgery and chemoradiotherapy for pharyngeal cancer in 2008. He was seen at our hospital because of discomfort at swallowing and was diagnosed as having cancer of the cervical esophagus spreading to the upper esophagus and the esophageal entrance. The patient underwent thoracoscopy assisted total pharyngo-laryngo-esophagectomy with 3 field domain lymph node dissection, followed by reconstruction using a free jejunal graft and gastric tube in April 2011. On the 23rd postoperative day, anastomotic leakage of the jejunogastrostomy was identified to form an enterocutaneous fistula, 10mm longand 3mm in diameter. Although fasting and enteral nutrition were employed after making a diagnosis of enterocutaneous fistula, the fistula was intractable. Direct closure of the fistula and administration of human plasma coagulation factor XIII also failed to close the fistula. Subsequently, we tried an injection of octyl-2-cyanoacrylate (DERMABOND®) into the fistula under fluoroscopy guidance. Immediately after the injection therapy performed twice, the fistula was closed completely. The patient is doing well without recurrence of enterocutaneous fistula one year after discharge from the hospital.<BR>Injection therapy with octyl-2-cyanoacrylate is simple and easy, and it might be the useful treatment of choice for intractable enterocutaneous fistula due to anastomotic breakdown following digestive tract surgery.

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