Limits...
The over-the-scope clipping system for treatment of chronic coloenteric fistula: a case report.

Radziunas G, Dulskas A, Aliosin O, Lunevicius R, Samalavicius NE - World J Surg Oncol (2015)

Bottom Line: Conservative treatment was unsuccessful.The orifice was then closed with two subsequent clips, and the patient recovered well.To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco.

View Article: PubMed Central - PubMed

Affiliation: Vilnius University Hospital Santariskiu Clinics, 2 Santariskiu Str, Vilnius, LT-08661, Lithuania.

ABSTRACT
Anastomotic leak in colorectal surgery is not very unusual. The over-the-scope clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested with animals, might be the choice for the patient. We presented the case of a 63-year-old man with chronic coloenteric fistula. Conservative treatment was unsuccessful. The orifice was then closed with two subsequent clips, and the patient recovered well. To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco.

No MeSH data available.


Related in: MedlinePlus

Same anastomotic defect seen on endoscopic evaluation
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4514455&req=5

Fig2: Same anastomotic defect seen on endoscopic evaluation

Mentions: In 5 days of short-course radiotherapy (25Gy), a low anterior resection with a defunctioning ileostomy was performed. The distance from the anastomosis to the anal verge was 5 cm. The postoperative period was uneventful, and the patient was discharged from the hospital on day 7. On the 9th day after the procedure, the patient was readmitted complaining of urinary retention, and a transcutaneous suprapubic cystostomy was performed. Later, the patient complained of dull pelvic pain, febrile fever, and some liquid discharge through the anus. On a contrast proctography, a presacral sinus of 10 × 9 × 4 cm and a leakage of a short-loop limb after side-to-end anastomosis of about 1.5 cm in diameter were found (Fig. 1a). Since he had a defunctioning ileostomy, conservative therapy was prescribed. After 6 months, an endoscopy was performed. During the procedure, the flexible sigmoidoscope was introduced into the anal canal, and a rectosigmoid anastomosis was seen: an afferent loop of sigmoid colon without abnormalities, in the end of an efferent loop—blind end of the J-shaped colon—a fistula of 1.5 cm in diameter was noted. The flexible endoscope was introduced through the fistula into the cavity (Fig. 2); several openings of the small bowel into the cavity were seen there—during suction, some yellowish, small bowel contents appeared. OTSC system (Over-The-Scope Clip, Ovesco Endoscopy GmbH, Tubingen, Germany) with the clip of t type (blunt teeth, with sharpened ends) was mounted on the endoscope, and the clip was applied on the fistula opening by using suction. Later, urografin (sodium amidotrizoate/meglumine amidotrizoate 30 and 76 %) was injected through the cannula to the site where the clip was applied—the majority of the contrast flew into the colon, but some contrast passed into the cavity. For a week, the patient had no liquid discharge through the anus. Later discharge through the anus appeared again. After 1 month, the procedure was repeated. During the endoscopy, we found that the previously applied clip had almost completely slipped off of the fistula opening, and so, we removed this clip with a polypectomy snare. After removal of the clip, an flexible endoscope was inserted into the cavity, and urografin was injected through the cannula: it was noted that the urografin passed into the small bowel. Another t-type clip was applied on the opening of the fistula using suction, and when we injected a contrast medium after the clip application, no contrast passed through the fistula (Fig. 1b). The patient did very well, and 1 month later, the proctography was normal and the ileostomy was reversed.Fig. 1


The over-the-scope clipping system for treatment of chronic coloenteric fistula: a case report.

Radziunas G, Dulskas A, Aliosin O, Lunevicius R, Samalavicius NE - World J Surg Oncol (2015)

Same anastomotic defect seen on endoscopic evaluation
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4514455&req=5

Fig2: Same anastomotic defect seen on endoscopic evaluation
Mentions: In 5 days of short-course radiotherapy (25Gy), a low anterior resection with a defunctioning ileostomy was performed. The distance from the anastomosis to the anal verge was 5 cm. The postoperative period was uneventful, and the patient was discharged from the hospital on day 7. On the 9th day after the procedure, the patient was readmitted complaining of urinary retention, and a transcutaneous suprapubic cystostomy was performed. Later, the patient complained of dull pelvic pain, febrile fever, and some liquid discharge through the anus. On a contrast proctography, a presacral sinus of 10 × 9 × 4 cm and a leakage of a short-loop limb after side-to-end anastomosis of about 1.5 cm in diameter were found (Fig. 1a). Since he had a defunctioning ileostomy, conservative therapy was prescribed. After 6 months, an endoscopy was performed. During the procedure, the flexible sigmoidoscope was introduced into the anal canal, and a rectosigmoid anastomosis was seen: an afferent loop of sigmoid colon without abnormalities, in the end of an efferent loop—blind end of the J-shaped colon—a fistula of 1.5 cm in diameter was noted. The flexible endoscope was introduced through the fistula into the cavity (Fig. 2); several openings of the small bowel into the cavity were seen there—during suction, some yellowish, small bowel contents appeared. OTSC system (Over-The-Scope Clip, Ovesco Endoscopy GmbH, Tubingen, Germany) with the clip of t type (blunt teeth, with sharpened ends) was mounted on the endoscope, and the clip was applied on the fistula opening by using suction. Later, urografin (sodium amidotrizoate/meglumine amidotrizoate 30 and 76 %) was injected through the cannula to the site where the clip was applied—the majority of the contrast flew into the colon, but some contrast passed into the cavity. For a week, the patient had no liquid discharge through the anus. Later discharge through the anus appeared again. After 1 month, the procedure was repeated. During the endoscopy, we found that the previously applied clip had almost completely slipped off of the fistula opening, and so, we removed this clip with a polypectomy snare. After removal of the clip, an flexible endoscope was inserted into the cavity, and urografin was injected through the cannula: it was noted that the urografin passed into the small bowel. Another t-type clip was applied on the opening of the fistula using suction, and when we injected a contrast medium after the clip application, no contrast passed through the fistula (Fig. 1b). The patient did very well, and 1 month later, the proctography was normal and the ileostomy was reversed.Fig. 1

Bottom Line: Conservative treatment was unsuccessful.The orifice was then closed with two subsequent clips, and the patient recovered well.To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco.

View Article: PubMed Central - PubMed

Affiliation: Vilnius University Hospital Santariskiu Clinics, 2 Santariskiu Str, Vilnius, LT-08661, Lithuania.

ABSTRACT
Anastomotic leak in colorectal surgery is not very unusual. The over-the-scope clipping (OTSC) system (Ovesco), which was originally developed to treat intestinal perforation and was tested with animals, might be the choice for the patient. We presented the case of a 63-year-old man with chronic coloenteric fistula. Conservative treatment was unsuccessful. The orifice was then closed with two subsequent clips, and the patient recovered well. To our knowledge, this is the first successful case of coloenteric fistula treatment with Ovesco.

No MeSH data available.


Related in: MedlinePlus