Case Report of International Journal of Case Reports
Successful use of a novel biological plug in the percutaneous treatment of a refractory gastro-cutaneous fistula following omental patch repair of perforated peptic ulcer
Allan Stolarski, MD1,2, Katherine He MD1,3, Ducksoo Kim MD4,5, Gentian Kristo, MD1,3
1Department of Surgery, Veterans Affairs Boston Healthcare System, Boston, MA, USA; 2Department of Surgery, Boston Medical Center, Boston University Medical School, Boston, MA, USA; 3Department of Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; 4Department of Interventional Radiology, Veterans Affairs Boston Healthcare System, Boston, MA, USA; 5Department of Interventional Radiology, Boston Medical Center, Boston University Medical School, Boston, MA, USA
Background: Gastro-cutaneous fistula following re-leak of omental patch repair of perforated peptic ulcer is a very rare but challenging surgical complication. We describe the use of a novel biological plug as a viable repair for gastro-cutaneous fistula that failed medical, endoscopic, and operative management. Additionally, we present a thorough literature review of reported cases of gastro-cutaneous fistulae following omental patching of peptic perforations to further highlight their treatment challenges.
Summary: A 69-year-old man underwent repair of a perforated pyloric ulcer with a pedicled omental patch. After one week, patient developed a re-leak from the omental patch, and underwent a second laparotomy with repeat omental patching of the gastric perforation. Ten weeks after the second operation, the patient developed a gastro-cutaneous fistula that failed conservative management with nil per os and enteral nutrition delivered distal to the fistula site; multiple image-guided percutaneous attempts at fistula closure by interventional radiology via fibrin sealant injection and collagen-based vascular closure device; and endoscopic clipping by gastroenterology. Ultimately, this refractory gastro-cutaneous fistula was closed with a novel biological plug (Biodesign® Enterocutaneous Fistula Plug, Cook Biotech).
Conclusion: Gastro-cutaneous fistulae following omental patching of perforated peptic ulcer represent a significant complication requiring a multidisciplinary management approach. The Biodesign® Enterocutaneous Fistula Plug offers a promising new tool for the non-operative treatment of refractory gastro-cutaneous fistulae.
Keywords: perforated peptic ulcer, omental patch, gastro-cutaneous fistula, fistula plug.
How to cite this article:
Allan Stolarski, Katherine He, Ducksoo Kim, Gentian Kristo. Successful use of a novel biological plug in the percutaneous treatment of a refractory gastro-cutaneous fistula following omental patch repair of perforated peptic ulcer. International Journal of Case Reports, 2020 4:121. DOI: 10.28933/ijcr-2020-02-2505
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