Enterocutaneous high output fistulae; octreotide an effective tool in management

Enterocutaneous fistula is an abnormal communication between epithelial lined lumen of Gl tract and epithelium of an adjacent viscous or skin. To find out role of octreotide in the management of high enterocutaneous fistula. Case study. Department of Surgery unit-ll Punjab Medical College and A and E Department of Jinnah Hospital /AIMC Lahore. From Jan 2007 to Dec 2008. 479 laparotomies were carried out due to trauma. Out of these 21 i.e. 4.38% developed high out put enterocutaneous fistula. All patients were put on similar conservative management including, TPN, antibiotics, fluid electrolyte replacement and stoma care. Patients were split into two groups alternatively. There were no statistical difference between the study groups with regard to the age [p-value=0.515]. Group I contains 11 patients [octreotide] received additionally 100mg octreotide S/C 8 hourly, showed decrease of volume from 680 to 150ml within 10 days. Spontaneous closure was observed in 8 [72.72%] patient and surgery was required in 2 [18.18%] patients. Death was 1 [9.09%]. In Group II remaining 10 patients[without octreotide], fistula discharge volume decreased form 650mg to 150ml in 20 days. Spontaneous closure was noted in 5 [50%] cases. Surgery was required in 3 [30%], while death rate was 2 [20%]. It is concluded that Octreotide, an analogue of somatostatin with longer half life is effective in treatment of high output fistula

Successful Treatment of Enterocutaneous Fistula in a Hemodialysis Patient with Somatostatin

Although cysticercosis is the most common parasitic disease affecting the central nervous system, spinal cysticercosis is rare. A rare form of spinal cysticercosis involving the whole spinal canal is presented. A 45-year-old Korean male had a history of intracranial cysticercosis and showed progressive paraparesis. Spinal magnetic resonance scan showed multiple cysts compressing the spinal cord from C1 to L1. Three different levels (C1-2, T1-3, and T11-L1) required operation. Histopathological examination confirmed cysticercosis. The patient improved markedly after surgery.

Multiple spontaneous enterocutaneous fistulae in malakoplakia.

Malakoplakia is a rare chronic inflammatory disease, usually involving the urogenital tract. We report a patient who presented with a psoas abscess, and later developed colocutaneous fistula at the site of abscess drainage and multiple spontaneous fistulae away from the site of incision. Histology of the resected specimen showed Michaelis-Gutmann bodies, which are diagnostic of malakoplakia.

Octreotida no tratamento de fístulas entéricas de ratos / Octreotide in treatment of enterocutaneous fistula in rats

Somatostatina e seu análogo sintético octreotida säo as drogas mais amplamente utilizadas para tratar fístulas enterocutâneas. Todavia, as evidências suportando seu uso ainda säo insuficientes. Objetivo: Investigar os efeitos terapêuticos de octreotida em um modelo experimental de fístula enterocutânea. Métodos: Em trinta ratos machos Wistar com peso 210 17g foi confeccionada cirurgicamente uma fístula jejunocutânea. Os animais foram aleatoriamente divididos em três grupos de dez. No grupo A, administrou-se uma dose única diária de octreotida (4 g/kg/peso corporal/SC) enquanto no grupo B injetou-se por via SC soluçäo salina a 0,9 por cento em quantidade idêntica à utilizada para veicular octreotida. O grupo C serviu de controle. Os roedores foram inspecionados a respeito do volume diário do débito das fístulas, tempo necessário para sua cicatrizaçäo espontânea, avaliaçäo clínico-bioquímica, hematológica e nutricional. Resultados: Os ratos tratados com octreotida näo tiveram significantes alteraçöes clínico-bioquímicas ou ponderais quando comparados ao controle (sem fístula) e cicatrizaram as fístulas espontaneamente em um tempo significativamente menor (3,8 1,6 dias) que os do grupo B (15,3 4,5 dias) (p < 0,05). No grupo B verificou-se queda ponderal média de 60 por cento ao final da pesquisa, com 40 por cento dos animais exibindo caquexia, anemia, hipoglobulinemia e hipoalbuminemia. Conclusäo: A octreotida foi superior ao placebo e permitem afirmar que, segundo as estritas condiçöes do experimento, o fármaco foi eficaz na cicatrizaçäo de fístulas enterocutâneas näo complicadas de ratos.

Experience with somatostatin analogue [octreotide] in gastrointestinal and pancreatic fistulae

Over a period of 2 years Somatostatin analogue [Octreotide] was administrated to 12 patients with enterocutaneous [EC] and 2 patients with pancreatic fistulae [PF] in a daily dose of 300ug/24 hr. There were 8 male and 6 female patients with an average age of 30.3 years [range 10-65 years]. In 9 patients with EC low output fistulae there was spontaneous closure and at least 50% reduction in 2 patients with high output fistulae which required further surgery. The two cases of pancreatic fistula also closed spontaneously in 5 to 8 days. Mean period for closure in 9 cases was 7.4 days [range 5-12 days]. There were fewer side effects and one death in high output fistula due to over whelming infection and septicemia. The results of this study favour the use of Octreotide in EC and pancreatic fistulae

Tratamiento de fístulas digestivas con somatostatina / Digestive fistula treated by somatostatina

El uso de la somatostatina en el tratamiento de las fístulas intestinales, ha demostrado ser un eficaz arma terapéutica, en el manejo conservador de esta patología, logrando el cierre espontáneo en 60 a 90% de los pacientes, en períodos significativamente inferiores a los obtenidos con la terapia convencional. Se presenta nuestra experiencia inicial, de dos pacientes, en el tratamiento de fístulas digestivas, con el péptido análogo de somatostatina SMS 201-995, logrando en ambos casos el cierre espontáneo de la fístula con manejo médico. Se analiza las propiedades farmacológicas de la somatostatina y las aplicaciones clínicas del péptido análogo SMS 201-995, sus efectos secundarios y los resultados alcanzados en la literatura

Sangrado postquirúrgico por carbenicilina / Postsurgical bleeding due to cabernicillin

Se presenta el caso de un adolescente de 14 años de edad que ingresó al hospital por fístula estercorácea como complicación de una apendicectomía. Diecinueve días después de su ingreso, se llevó a cabo la resección de la fístula sin complicaciones transquirúrgicas. Se administró carbenicilina a 400 mg/kg/día; dos horas después de la primera dosis, presentó sangrado masivo que ameritó reintervención encontrándose 500 ml de sangre libre en cavidad. Se demostró disfución plaquetaria. Se suspendió la carbenicilina y se manejó con plasma rico en plaquetas, con lo que se controló el episodio hemorrágico. Se discute la fisipatología y se revisa la literatura al respecto