RESUMO
INTRODUCTION: The complicated diverticulitis of the colon is characterized by its association with abscesses, bleeding, stenosis, perforation, obstruction or fistula. We report a case of spontaneous sigmoido-cutaneous fistula from diverticulitis to an unusual place in the gluteal region. CLINICAL CASE: A 59-year-old male patient presented an inflammatory wound in left buttock without response to the conservative medical treatment. The fistulography, colonoscopy, barium enema and computed tomography showed a sigmoido-cutaneous fistula to the left buttock from diverticulitis. The biopsy of the lesion ruled out malignancy. We performed an elective sigmoid resection with primary colorectal anastomosis, partial fistulectomy and injection of a fibrin sealant in the residual tract. DISCUSSION: The colon-cutaneous fistulas from diverticulitis are relatively rare. We report a spontaneous fistula with origin in a single diverticulum in the sigmoid colon and that drained through the piriform fossa of the pelvic floor to the skin of the left buttock. CONCLUSIONS: A high index of suspiscion is necessary to not confuse the colo-buttock fistula with local abscesses.
Assuntos
Fístula Cutânea/etiologia , Diverticulite/complicações , Fístula Intestinal/etiologia , Doenças do Colo Sigmoide/etiologia , Idoso , Amiloidose/complicações , Anastomose Cirúrgica , Antibacterianos/uso terapêutico , Doença Crônica , Colonoscopia , Terapia Combinada , Curetagem , Fístula Cutânea/diagnóstico , Fístula Cutânea/tratamento farmacológico , Fístula Cutânea/cirurgia , Diverticulite/diagnóstico , Diverticulite/tratamento farmacológico , Drenagem , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/etiologia , Adesivo Tecidual de Fibrina , Humanos , Fístula Intestinal/diagnóstico , Fístula Intestinal/tratamento farmacológico , Fístula Intestinal/cirurgia , Nefropatias/complicações , Masculino , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/tratamento farmacológico , Doenças do Colo Sigmoide/cirurgiaAssuntos
Doença de Crohn/complicações , Fístula Cutânea/terapia , Períneo , Fístula Retal/terapia , Antibacterianos/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Anticorpos Monoclonais/uso terapêutico , Ciprofloxacina/administração & dosagem , Ciprofloxacina/uso terapêutico , Doença de Crohn/terapia , Fístula Cutânea/tratamento farmacológico , Fístula Cutânea/cirurgia , Endossonografia , Feminino , Humanos , Oxigenoterapia Hiperbárica , Infliximab , Imageamento por Ressonância Magnética , Masculino , Metronidazol/administração & dosagem , Metronidazol/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Fístula Retal/tratamento farmacológico , Fístula Retal/cirurgia , Fístula Retovaginal/tratamento farmacológico , Fístula Retovaginal/cirurgia , Fístula Retovaginal/terapia , Tacrolimo/administração & dosagem , Tacrolimo/uso terapêuticoAssuntos
Fístula Biliar/tratamento farmacológico , Fístula Cutânea/tratamento farmacológico , Fitoterapia , Complicações Pós-Operatórias/tratamento farmacológico , Parede Torácica , Idoso , Diagnóstico Diferencial , Medicamentos de Ervas Chinesas/uso terapêutico , Fístula/tratamento farmacológico , Humanos , Masculino , Medicina Tradicional Chinesa , Pessoa de Meia-Idade , Coxa da PernaRESUMO
Anecdotal reports support the use of octreotide in the treatment of traumatic thoracic duct injuries and chylothorax, but no prospective studies have proved its efficacy. We evaluated the effects of octreotide in treating thoracic duct transection in a canine model. Eight mongrel dogs (27.8+/-5.1 kg) were fed one pint of 10.5 per cent milkfat 2 hours before operation. Through a left supraclavicular neck incision, the thoracic duct was identified and transected, producing free flow of chyle. A quarter-inch drain was tunneled subcutaneously from the wound and attached to closed suction. After wound closure dogs were randomized to a control group (n = 4) receiving sham injections of saline subcutaneously three times per day, or a treatment group (n = 4) given 3 microg/kg octreotide three times per day. Postoperatively all dogs were fed a standard low-fat (5-7%) crude fat diet. Drain output was measured each day, and on odd-numbered postoperative days the drainage was analyzed for cholesterol, triglycerides, albumin, and total protein. Fistula closure was defined as drainage <10 ml/24-hour period. Treated dogs achieved fistula closure significantly faster than controls: 3.5+/-1.3 days versus 7.8+/-1.0 days (P = 0.0037). Whereas equivalent amounts of drainage occurred on the day of surgery and on postoperative day one in both groups, by postoperative day 2 the treatment group had significantly less drainage over 24 hours: 63+/-69 ml versus 195+/-79 ml (P = 0.046); this significant difference persisted through postoperative day 5 when drainage began to decrease in the control group. No significant differences between groups were seen in levels of cholesterol, triglycerides, albumin, or protein in the drainage at any time point. We conclude that octreotide is effective in treating thoracic duct injury, leading to an early decrease in drainage and early fistula closure. The mechanism for this effect remains to be clarified.
Assuntos
Quilotórax/tratamento farmacológico , Quilotórax/etiologia , Fístula Cutânea/tratamento farmacológico , Fístula Cutânea/etiologia , Fármacos Gastrointestinais/uso terapêutico , Complicações Intraoperatórias/tratamento farmacológico , Complicações Intraoperatórias/etiologia , Octreotida/uso terapêutico , Ducto Torácico/lesões , Animais , Quilo/efeitos dos fármacos , Quilo/metabolismo , Quilotórax/diagnóstico , Fístula Cutânea/diagnóstico , Modelos Animais de Doenças , Cães , Drenagem , Avaliação Pré-Clínica de Medicamentos , Fármacos Gastrointestinais/farmacologia , Complicações Intraoperatórias/diagnóstico , Octreotida/farmacologia , Distribuição Aleatória , Fatores de TempoRESUMO
OBJECTIVE: To evaluate the use of octreotide together with the conservative handling in the treatment of patients with external gastrointestinal fistulae. MATERIAL AND METHODS: Clinical essay in postsurgical gastrointestinal fistulae carriers assisted during a 54-month period. They were randomly distributed in two groups: group A was treated with conventional handling and group B was additionally treated with octreotide. RESULTS: 44 women and 55 men with an average age of 50 +/- 19 years old were treated. The following table summarizes the result variables. [table: see text] CONCLUSION: The use of octreotide is recommendable, for it was useful in diminishing both the closing time of the fistula and the time the nutritional support the patient requires. Mortality still continues to be very increased (because of sepsis), by which the phrase "primum non nocere" takes a relevant place since this pathology is greatly preventable.