Non-healing post-surgical fistulae: treatment with image-guided percutaneous injection of cyanoacrylic glue

• Published in: Radiologia medica 2017-02, Vol.122 (2), p.88-94
• Main Authors: Mauri, Giovanni, Pescatori, Lorenzo C., Mattiuz, Chiara, Poretti, Dario, Pedicini, Vittorio, Melchiorre, Fabio, Rossi, Umberto, Solbiati, Luigi, Sconfienza, Luca Maria
• Format: Article
• Language: English
• Subjects: Abdominal Radiology; Adult; Aged; Aged, 80 and over; Computation; Computed tomography; Cyanoacrylates - administration & dosage; Diagnostic Radiology; Digestive System Surgical Procedures - adverse effects; Feasibility Studies; Female; Fluoroscopy; Healing; Humans; Imaging; Injections, Intralesional; Interventional Radiology; Intestinal Fistula - etiology; Intestinal Fistula - therapy; Male; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Postoperative Complications - therapy; Radiography, Interventional - methods; Radiology; Retrospective Studies; Tissue Adhesives - administration & dosage; Tomography, X-Ray Computed - methods; Treatment Outcome; Ultrasound; Wound Healing
• ISSN: 0033-8362; 1826-6983
• DOI: 10.1007/s11547-016-0693-7

Objectives To present the results of our experience with cyanoacrylic glue percutaneous injection to treat post-surgical non-healing enteric fistulae after failure of standard treatments. Methods Eighteen patients (14 males; age range 33–84, mean 69 years) were treated for a non-healing post-surgical enteric fistula after failure of standard treatments. Under computed tomography and/or fluoroscopic guidance, a mixture of cyanoacrylic glue (Glubran 2, GEM, Viareggio, Italy) and ethiodized oil was injected at the site of the fistula. Fistula was considered healed when no material was drained by the percutaneous drainage and a subsequent computed tomography confirmed the disappearance of any fluid collection. Results In all cases, it was possible to reach the site of the fistula using a percutaneous access. A median of 1 injection (range 1–5) was performed. Fistula healing was achieved in 16/18 (89 %) patients. One patient died for other reasons before fistula healing. Median time for fistula healing was 0 days (mean 8, range 0–58 days). No complications occurred. Reoperation was needed in one patient. Conclusions Percutaneous injection of cyanoacrylic glue is feasible, safe, and effective to treat non-healing post-surgical enteric fistulae. It may represent a further option to avoid surgical reoperation in frail patients.