[Intestinal fistulas as rare complications in operated, primarily not diagnosed Hirschsprung's disease].
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A retrospective and prospective analysis was carried out of 48 patients with 54 enterocutaneous small bowel fistulae. 31 patients received total parenteral nutrition (TPN) by 17 patients only the daily losses of fluids and electrolytes were covered. In 19 fistulae (39,5%) closed spontaneously (48,5% with TPN and 14,3% without TPN). 10 patients underwent surgery; 5 fistulae closed operatively. The efficacy of treatment of enterocutaneous fistulae was influenced by the location of fistula, by the daily output, by the septic complications and by the use of TPN. Total parenteral nutrition can be the primary treatment or an effective adjunct to supplement the surgical management of postoperative small bowel fistulae.
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The use of two recently introduced skin protective preparations in the treatment of perifistular skin inflammation is described. Karaya gum in paste form (karaya paste) and a compressed wafer of gelatin, pectin and methyl cellulose (Stomahesive) were used, alone or in combination; with drainable collecting appliances. The method protects the inflamed skin from fistula discharge and allows healing to proceed beneath the dressing. A technique to improve the adhesion of the appliance, in spite of large fluid losses, is outlined. Healing of skin excoriation was obtained in nearly all cases. Complete control of leakage was achieved in a group of patients with a high output fistula.
We describe herein the case of a 3-year-old child in whom a jejunoileal fistula was caused by the ingestion of magnets. This case report demonstrates that if more than one magnet is found as a foreign body in the intestine, they should not be left untreated even if there are no sharp edges and, it seems they could be evacuated spontaneously. This recommendation is made because the magnets will attract each other and hold the intestinal walls between them, causing necrosis and resulting in intestinal perforation or a fistula.
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