Percutaneous management of enterocutaneous fistulas

OBJECTIVE. Our objective was to evaluate retrospectively the. results of percutaneous catheter management of enterocutaneous fistulas. SUBJECTS AND METHODS. From 1983 to 1995, 147 patients with enterocutaneous fistulas were referred to our department after at least 1 month of unsuccessful medical treatment, One hundred eleven of these patients (76%) had developed fistulas after surgery. Ninety-three of 147 patients (63%) had high-output fistulas, and 54 (37%) had low-output fistulas. Patients underwent fluoroscopically guided catheterization of the fistulous tracts and cannulation of the enteric segments. Abscesses were drained either through the cutaneous orifice or under CT or sonographic control when no communication with the fistulous tract existed. RESULTS. We defined success as closure of the fistulous tract and the cutaneous orifice and definitive healing of abscesses, The overall closure rate was 81%. The respective clinical success rates for high-output fistulas and low-output fistulas were 90% with a mean duration of 32 days and 65% with a mean duration of 45 days. CONCLUSION. Percutaneous management of enterocutaneous fistulas is a valuable therapeutic approach in patients not responding to medical treatment, particularly patients with high-output fistulas.