[Esophageal perforation and postoperative fistulae of the upper digestive tract treated endoscopically with the application of Tissucol].
We present three patients with serious gastro-esophageal complications which were treated with Tissucol. The first patient developed a rare postoperative oesophago-pleural fistula. The second suffered a traumatic esophageal perforation (possibly iatrogenic) that was discovered at the end of the removal procedure of an alimentary bolus impacted in the distal esophagus. Attempts to close the high output oesophago-pleural fistula with standard treatment were unsuccessful. It was closed with Tissucol at the third attempt, in conjunction with oesophago-jejunal stenosis by means of endoscopic dilatation. In the second patient, early Tissucol application after detection of pneumomediastinum was an effective complementary treatment to the conservative approach and rapidly closed the perforation. The third patient developed a low debit postoperative gastro-cutaneous fistula that did not resolve with conservative treatment. It was closed with only one session of Tissucol sealing. We consider that the endoscopic application of fibrin glue should become the first step in the conservative treatment of small esophageal perforations or postoperative esophageal pleural fistulae, especially in cases of high output fistulae. The success of this technique depends on the localization and selective catheterization of the fistula and on brushing the fistular opening. Total resolution of any distal stenosis is necessary to prevent reopening of the fistula.
Rábago
L R
LR
Sección de Aparato Digestivo, Hospital Severo Ochoa, Madrid. lrabagot@meditex.es
Castro
J L
JL
Joya
D
D
Herrera
N
N
Gea
F
F
Mora
P
P
Blesa
C
C
D000328:Adult; D000368:Aged; D002760:Cholangiopancreatography, Endoscopic Retrograde; D016154:Digestive System Fistula / Q000188:drug therapy* / Q000209:etiology; D004937:Esophageal Fistula / Q000188:drug therapy* / Q000209:etiology; D004939:Esophageal Perforation / Q000188:drug therapy* / Q000209:etiology; D004947:Esophagus / Q000293:injuries; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy* / Q000209:etiology; D014014:Tissue Adhesives / Q000627:therapeutic use*
D015718:Fibrin Tissue Adhesive; D014014:Tissue Adhesives