Closure of duodenocutaneous fistula due to recurrent colon cancer with a pedicled jejunal seromuscular flap

• Published in: Surgery today (Tokyo, Japan) Vol. 36; no. 10; pp. 941 - 943
• Main Authors: Oshiro, Taihei, Moriura, Shigeaki, Yoshioka, Yuichiro, Kawahara, Mari, Kobayashi, Ichiro, Matsumoto, Takatoshi
• Format: Journal Article
• Language: English
• Published: Japan 01.10.2006
• Subjects: Aged, 80 and over; Colonic Neoplasms - complications; Cutaneous Fistula - etiology; Cutaneous Fistula - surgery; Duodenal Diseases - etiology; Duodenal Diseases - surgery; Fatal Outcome; Female; Humans; Intestinal Fistula - etiology; Intestinal Fistula - surgery; Intestinal Mucosa - transplantation; Jejunum - cytology; Jejunum - transplantation; Neoplasm Recurrence, Local - complications; Surgical Flaps
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-006-3258-x

A new approach to closing a malignant enterocutaneous fistula is reported. Transverse colon cancer recurred around the superior mesenteric vein along with a duodenocutaneous fistula, thus causing severe dermatitis. The tumor was partially resected at the fascia level and the fistula measured 2.5 cm in diameter. A left rectus abdominis musculocutaneous flap failed to close the fistula because of graft necrosis. A jejunal flap measuring 8 cm in length was prepared by sacrificing about 15 cm of adjacent jejunum to create the pedicle. The mucosal layer of the flap was removed and the fistula was closed, then the tumor surface was covered. Two weeks later, the skin defect was covered with free skin grafting. The patient died of cancer 6 months after surgery, but there was no recurrence of the fistula.