Precise application of fibrin glue into a fistula between the rectal stump and urinary bladder – a new technique
Jason Ooi, John Stanley, Nathan Lawrentschuk
Am J Case Rep 2008; 9:178-181
Background: Surgical excision and primary closure of colovesical fistulas may not be feasible in patients with a history of previous surgery, radiation or having multiple co-morbidities. Endoscopic closure with fi brin glue is minimally invasive and can provide effective palliation of symptoms. We describe a new technique to accurately apply fibrin glue into the fistula opening.
Case Report: A double-barrelled application catheter (Duplocath- Baxter, Compton, UK) was passed through a colovesical fistula under vision to ensure reliable injection of fibrin glue along the entire fistula tract. The accurate application of fibrin glue within the fistula was instrumental in helping to manage a dificult fistula in a complex patient.
Conclusions: Endoscopic closure of genito-urinary fistula with fibrin glue remains an important option for first-line therapy. The principles of our technique may assist difficult recto-vesical fistula cannulation, facilitate accurate glue application and locate fistula opening in the rectum.
Keywords: Intestinal Fistula, Surgical procedures minimally invasive, fibrin tisssue adhesive, Endoscopy, Catheterization