Slovenská chirurgia 2-3/2017
Rare spontaneous formation of bilioenteric fistula in a patient with an open abdomen treated by VAC therapy – a case report
Perforation of the lateral duodenal wall is one of the most serious complications of ERCP examination and usually requires surgical intervention. Despite the early intervention, this lesion can lead to serious complications including the development of acute necrotic pancreatitis. As a result of acute necrotic pancreatitis, retroperitoneal necrosis develops with the development of the abdominal compartment syndrome, and therefore the open abdomen method is indicated in the treatment of these patients. Among all of the techniques used today in open abdomen management, VAC therapy is considered to be the most effective. This work presents the case of a patient who suffered from duodenal perforation during ERCP examination with the development of acute necrotic pancreatitis followed by treatment of the open abdomen by VAC therapy. The patient was repeatedly revised for high-output duodenal fistula, and in the last procedure duodenopancreatectomy was performed with blind closure of the hepatocholedochus with leaving the T-drainage of bile ducts as an external biliary drainage with planned delayed realization of biliodigestive anastomosis in the second stage. The open abdomen was managed by regular VAC system changes – the abdominal set by reducing the size of the abdominal wall defect by performing a gradual dynamic secondary suture. During the treatment of the open abdomen by the VAC method, a spontaneous formation of the bilioenteric fistula occurred. There was no evidence in literature of spontaneous fistula formation between the biliary system and the gastrointestinal tract in patients with open abdomen treated with VAC therapy.
Keywords: ERCP, perforation of the duodenum, surgical treatment, open abdomen, intraabdominal VAC system, bilioenteric fistula
