title: Novel approach to the treatment of intestinal fistula in the inaccessible abdomen: transbursal end-to-side duodenogastrostomy.
abstract: BACKGROUND
  Treatment of enterocutaneous fistula in patients with intra-abdominal sepsis and a surgically inaccessible abdomen is frequently unsuccessful.
  
  
  METHODS
  A new approach has been devised: total disconnection of the proximal digestive tract, which can be performed through the bursa omentalis without entering the scarred abdomen.
  
  
  RESULTS
  The procedure was carried out in four patients with high-output small bowel fistula and an inaccessible abdomen. Output of fistulas stopped promptly, recovery from intra-abdominal sepsis was achieved, the abdomens became accessible again and continuity of the digestive tract could be restored in all patients after intervals of 2-5.5 months.
  
  
  CONCLUSIONS
  Transbursal end-to-side duodenogastrostomy is a useful procedure when traditional surgical interventions have failed or cannot be applied.
authors.affiliation: Department of Surgery, University Hospital Utrecht, The Netherlands.
authors.forename: K
authors.initials: K
authors.lastname: Bosscha
authors.forename: T J
authors.initials: TJ
authors.lastname: van Vroonhoven
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D017577:Cutaneous Fistula / Q000601:surgery*; D004385:Duodenostomy / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000517:prevention & control; D016896:Treatment Outcome