FROM CLASSIC TO MODERN PROCEDURES IN THE TREATMENT OF EARLY EXTERNAL HIGH-OUTPUT POSTOPERATIVE DIGESTIVE FISTULAS.

Pacients with entero-cutaneos fistula may represent a real challenge for surgeons, requiring close monitoring and also an optimal approach regarding the invasive gestures. We report the use of two classic methods, combined with modern ones, for closure of a high-output duodenal fistula in a patient who had undergone duodenal surgical treatment for obtaining hemostasis in a higher digestive haemorrhage. We present the case of a 46 year-old patient, admitted in our service for an external postoperative digestive fistula arising in the context of mixed decompensated liver cirrhosis with toxic etiology after a surgical intervention for a duodenal bleeding ulcer. The patient developed an early (48h) external postoperative digestive fistula. After the clipping intervention, a compression dressing is applied, so that the flow rate of the fistula becomes minimal. The progressive decrease of drainage during 7 post-operative days imposed approaches like the model of instillation-suction of lactic acid (Tremoliere) and of Monica Roşca meshing for solving the digestive fistula. After the cessation of digestive secretion, a rapid process of scarring and wound retreatment occurs, alongwith the appearance of reepithelial edges, due to patient's status, which did not permit classic surgery for the closure of the abdominal wall, so that treatment with negative pressure to close the wound was decided. [ABSTRACT FROM AUTHOR]