NOVEL-APPROACH TO THE TREATMENT OF INTESTINAL FISTULA IN THE INACCESSIBLE ABDOMEN - TRANSBURSAL END-TO-SIDE DUODENOGASTROSTOMY

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 disconnec tion of the proximal digestive tract, which can be performed through t he bursa omentalis without entering the scarred abdomen. Results The p rocedure was carried out in four patients with high-output small bowel . fistula and an inaccessible abdomen. Output of fistulas stopped prom ptly, 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. Conclusion Transbursal end-to-side duodenogastrostomy is a useful procedure when traditional surgical interventions have failed or cannot he applied.