MANAGEMENT OF DUODENAL FISTULA BY INTRALUMINAL CONTINOUS ASPIRATION

Abstract

Duodenal fistula has a high morbidity and mortality rates due to uncontrolled sepsis, high output, malnutrition and multiple operations. Most of these patients are not good candidates for another operation. We report a modified approach to the conservative management of duodenal fistulas with continuous intraluminal aspiration. Double lumen catheter was inserted at the level of duodenal fistula with the aid of a flexible gastroscope. This technique was used in five patients. The output of duodeno-cutaneous fistula was significantly decreased on the first day following the intraluminal continuous aspiration (the mean fistula output was 2450 ml before the continuous aspiration vs 725 ml afterwards, p<0.01 ) and continued to decreased progressively thereafter. Mean time for fistula closure after continuous intraluminal aspiration was 13 (7-17) days. This simple technique is effective in preventing complications due to duodenal fistula.