A Case of an Ileal Fistula for 50 Years

Kiminori Tanifuji, Fumihito Ikeda, Soh Katayanagi, Kazuhiko Kasuya, Kazuhiro Tanifuji, Yasuhisa Kyanagi*

Department of Surgery, Tanifuji Hospital
*Department of Surgery, Tokyo Medical College

It is well known that an unused intestinal tract after colostomy or ileostomy for various conditions shows atrophic changes. We investigate histopathologically the case of an external fistula of the ileum with ileum and colon unused for 50 years. A 73-year-old woman, who had a past history of surgical treatment of an ovarian disease and ileus at another hospital, had the complication of an external fistula of the ileum for 50 years. We performed laparotomy and resected the fistula, surrounding adhesive ileum, the distal ileum and the cecum for a length of the about a meter. Macroscopical findings of the resected specimen were marked atrophy of the wall and muscle layer of the distal ileum to the fistula and the colon. In histological sections of the surgical specimen, we found almost normal villi and crypts with brush border/microvilli, but low density and short length of tubules in the distal ileum to the fistula. We refer to a paper which reported that a total abstinence from food made brush border/microvilli be lost in the mucosa of an unused alimentary canal, a continued oral diet was important to maintain absorbing function (brush border/microvilli). Histologically, there was marked chronic inflammatory cell infiltration in the unused colonic mucosa, however, these findings disappeared at the colonic biopsy specimen a year after the operation. We propose that a form of nonspecific colitis is one of the cause of absorbing dysfunction.

Key words
external fistula of intestine, atrophy of unused intestine, absorbing dysfunction of reused colon

Reprint requests
Kininori Tanifuji Department of Surgery, Tanifuji Hospital
3-15, Futabacho, Kushiro-city, 085 JAPAN

Accepted
May 8, 1996

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