Application of A Cardiac Septal Occluder in A Patient Affected By Enteroatmospheric Fistula - Application of A Cardiac Septal Occluder in A Patient Affected By Enteroatmospheric Fistula - Open Access Pub

Enteroatmospheric fistula is a challenging and emerging clinical situation, mainly related to “open abdomen” technique in damage control surgery for trauma and in case of multiple laparotomies. We report the case of a 61-year-old male patient, affected by rectal carcinoma, submitted to standard surgical treatment and gradually evolving in persistent proximal jejunal fistula. The positioning of a cardiac septal occluder (Amplatzer？) was associated with immediate and late favourable effects. The procedure was conducted “bed-side” and turned out to be easy and safe. DOI10.14302/issn.2471-7061.jcrc-14-579 Enteroatmospheric fistula (EAF) is a challenging clinical situation: the increasing frequency that is observed and reported worldwide is mainly correlated to the “open abdomen” technique1, 2: this technique is used in damage control surgery for trauma and in patients submitted to multiple laparotomies3, 4 . EAF is defined as a single or multiple communications between the visceral lumen and the atmosphere: EAFs (enteroatmospheric fistulas) are superficial or deep depending on the origin of the fistulas. Standard treatment of EAFs includes: ·Drainage of the output ·Total parenteral (TPN) and/or enteral (TEN) nutrition ·Prevention and control of infection and sepsis The management of such patients is typically made in Intensive Care Units (ICU) but, in spite of all the above therapies spontaneous closure is extremely unlikely; consequently the morbidity and the mortality are very high, often in association with a long hospitalization. Furthermore, a “road map” is needed for an accurate definition of the number and site of EAFs5, using radiologic techniques, computed tomography (CT), fistulography and oral or nasogastric ingestion of charcoal or dye. Figure 1. Nitinol occluder system (Amplatzer？) Figure 2. Nitinol occluder system (Amplatzer？) Despite many adopted surgical and non-surgical techniques, a fully satisfactory method to treat this type of fistulas has not yet been described. The aim of this study is to present a new technique to attempt the closure of an EAF by the positioning of a nitinol occluder system, a self-expandable double-umbrella-shaped device made of a nickel-titanium alloy (Figure 1, Figure 2). A 61-year-old male patient, affected by rectal carcinoma, underwent a open standard anterior rectal resection. The postoperative course was particularly complex including postoperative haemorrhage, intestinal obstruction and perforation with the final arising of a jejunal multirecurrent EAF. The multistep treatment included many laparotomies with