PROCEDURE:Â
- Fistulogram of a colocutaneous fistula.
- Contrast study of the distal colon and rectum
- Balloon dilatation of a colonic stricture
- Colocutaneous fistula tract debridement using a Trerotola device
- Colocutaneous fistula closure/embolization with Tisseel fibrin glue
DATE OF PROCEDURE:Â Â Â Â
INDICATION:   old  ,   The stricture was last balloon dilated on _______.
COMPARISON: None
OPERATORS: John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â
MEDICATIONS: Versed 6 mg IV, fentanyl 300 mcg IV, Dilaudid 5 mg IV
CONTRAST: 75 ml nonionic contrast
FLUORO TIME: Â Â minutes
ACCESS SITE:Â Existing left lower quadrant colocutaneous fistula orifice.
COMPLICATIONS: None
TECHNIQUE:
The risks, benefits, and alternatives to the procedure and sedation were explained to the patient. Written informed consent was obtained.Â
The patient was assessed for conscious sedation and found to be an adequate candidate. A dedicated nurse monitored heart rate, blood pressure, and oxygen saturation throughout the procedure. A time out was performed prior to procedure initiation.
The right groin was prepped and draped in sterile fashion.Â
Using a Kumpe catheter and Glidewire, the colocutaneous fistula was negotiated and access obtained to the colon.
The Glidewire was replaced for an Amplatz catheter. A 7 F sheath was advanced over the wire into the colon. The sheath was pulled back and a contrast study of the colon as well as a fistulogram were performed.
A 22 mm x 4 cm balloon catheter was used to dilate the previously seen anastomotic stricture.
A buddy wire was placed through the sheath. The sheath was removed and a pigtail catheter was placed over one of the wires. The sheath was reinserted over the other wire which was removed. The colocutaneous fistula tract was sanitized using hydrogen peroxide. A Trerotola thrombectomy device was inserted through the sheath and used to debride the colocutaneous fistula tract.
The colocutaneous fistula was again sanitize with hydrogen peroxide. The sheath was replaced over the wire. A dual-lumen PICC line was placed into the colon. The sheath was pulled back. Tisseel fibrin glue was injected through the dual lumen PICC as it was pulled back out of the colocutaneous fistula. The glue was cut at the skin surface. A sterile dressing was applied.
No immediate complication occurred, and the patient was discharged from the angiography suite in satisfactory condition.
FINDINGS:
- Persistent colocutaneous fistula arising proximal to the surgical anastomosis.
- Colocolonic fistula arising proximal tothe anastomosis appears smaller than on the prior study.
- Persistent moderate stricture at the anastomosis appears improved from the prior study.
- Near complete resolution of the fistula seen after dilatation with a 22 mm balloon.
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IMPRESSION:
Uneventful colonic anastomosis dilatation and enterocutaneous fistula closure/embolization with fibrin glue.
PLAN:
A patient will return to clinic in one month for evaluation of the colocutaneous fistula.