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

[6,7] We report the use of two classic methods, combined with modern ones, for closure of a high-output duodenal fistula in a patient having undergone duodenorrhaphy as a surgical treatment for obtaining hemostasis in the case of extended digestive haemorrhage. 2.CASE PRESENTATION A 46 year-old patient has been admitted in our service for an external postoperative digestive fistula arising in the context of mixed decompensated liver cirrhosis with toxic etiology. The initial clinical diagnosis was suspicion of external digestive fistula by the presence of large bile contents at surgical site, yet clearly evidenced by the ingestion of methylene blue, which is excreted within approximately 10 minutes after administration and was subsequently confirmed radiologically, by the ingestion opaque index (Fig. 2). In the evening of admission, the patient displays a haemorrhage expressed in the surgical site through the external fistulous tract, so that suppression of 3 suture threads was done, as well as a compressive dressing and administration of two blood units izogrupizo Rh and of one plasma unit, concomitantly with the transfer of the patient in the intensive care unit. The progressive decrease of drainage during 7 post-operative days imposed approaches, such as the model of instillation-suction of lactic acid (Tremoliere) (Fig. 6) and of Monica Roşca meshing (Fig. 7) for solving the digestive fistula, with a flow reduction up to 200 ml in the 8th postinterventional day; on the 10th day after surgery, the fistula flow drops below 100 ml / 24 hours.