Endoscopic treatment of a gastrocutaneous fistula in a chil.

Autores de IIS La Fe

• Miguel Couselo Jerez

  Autor

• Estíbaliz Valdés Diéguez

  Autor

• Vicente Ibáñez Pradas

  Autor

Grupos

• Hepatología experimental y Trasplante hepático

Abstract

INTRODUCTION: Gastric leaks and gastrocutaneous fistulae (GCF) after digestive surgery are unusual in children. Common treatments are based on conservative measures and surgery but endoscopic techniques are not a widespread option in pediatrics. CASE REPORT: An underweight child developed a GCF after surgery (esophagocoloplasty with right colon). It was managed endoscopically, placing double J ureteral stents (DJUS) with one tip in the gastric lumen and the other tip exiting through the cutaneous orifice via the fistula. A laminar drain was used to evacuate the intra-abdominal cavity. The patient was fed with a gastro-jejunal tube and the diameter of DJUS was reduced progressively. Ninety-two days after the initial endoscopic therapy the gastric orifice was closed. There were no severe complications or recurrences. DISCUSSION: The relevance of this case lies in the low prevalence of this complication and in the innovative endoscopic approach in children, which was safe and effective. INTRODUCCION: Las fugas gastricas y las fistulas gastrocutaneas (FGC) tras una cirugia digestiva son poco frecuentes en ninos. Los tratamientos habituales consisten en cirugia y medidas conservadoras, sin que las tecnicas endoscopicas resulten una opcion extendida en pediatria. CASO CLINICO: Paciente pediatrico con deficit ponderal que desarrollo FGC tras una cirugia (esofagocoloplastia con colon derecho). La FGC se abordo por via endoscopica, colocandose cateteres ureterales doble J (CUDJ) con un extremo en la luz gastrica y el otro saliendo por el orificio cutaneo a traves de la fistula. Se empleo drenaje laminar para evacuar la cavidad intraabdominal. El paciente recibio alimentacion a traves de sonda gastroyeyunal, reduciendose progresivamente el diametro de los CUDJ. A los 92 dias de la terapia endoscopica inicial, se cerro el orificio gastrico. No se registran complicaciones graves ni recidivas. COMENTARIOS: La relevancia de este caso reside en la baja prevalencia de esta complicacion y en lo innovador del abordaje endoscopico en ninos, que resulto seguro y eficaz.

Keywords

• Child; Endoscopy, gastrointestinal; Gastric fistula; Therapeutics