Treatment of external intestinal fistulas in children

Abstract

Aim. To study the features of surgical treatment of external fistulas.

Materials and methods. 16 children aged from 9 months to 18 years with external intestinal fistulas were observed in the current study. Among the causes that led to the formation of fistulas, an appendix abscess and peritonitis were the most common, occurring in 12 patients.

Results. In most patients, labiform fistulas were found in the small intestine, whereas tubular fistulas were more common in the colon. The diagnosis was based on the nature of the intestinal discharge, which helped to specify the location of the fistula. For example, discharges from small bowel fistulas contained bile, whereas those from large bowel fistulas more often resembled solid stool. Six patients had solitary fistulas, while the others had two to five fistulas, including combinations of small and large intestinal fistulas. Multiple fistulas were associated with more complex diagnostic and therapeutic challenges. In nine cases, surgical management included resection of the affected segment of small bowel with construction of an end-to-end anastomosis. All surgical procedures were complicated by significant adhesions in the peritoneal cavity, requiring special care and careful planning by the surgeon.

Conclusions. Surgical intervention was complicated in all cases by a pronounced adhesive process in the abdominal cavity.