A Case of External Intestinal Fistula for 44 Years

Yukihiro Funada, Genichi Nakano, Ryuichi Kikuchi*, Yuzo Uchida*

Department of Surgery, Usa Gastrointestinal Hospital
*Department of Surgery II, Oita Medical University

We encountered a case of external intestinal fistula that developed after resection of the colon and had been left untreated for 44 years. This report describes the functional and histological changes of the long-diverted large intestine and anus, detected during the treatment. The patient was a 69-year-old man who consulted our hospital with the chief complaint of dermatitis around the intestinal fistula. Only the sigmoid colon and rectum of the large intestine remained, and there was a subcutaneous anastomosis with the ileum, forming an external intestinal fistula. In the rectal biopsy specimen, mucosal chronic inflammatory infiltration, crypt distortion and atrophy, and surface erosions were detected histologically. We resected the intestinal segment containing the fistula and performed an ileoproctostomy. For two months postoperatively, aqueous soft stools were seen. This was presumably caused by dysfunction of water absorption due to disuse. Rectal biopsy performed three months later revealed that the inflammatory findings had disappeared. Though maximum resting pressure of the anal canal was as low as 40 cmH₂O before surgery, it had recovered to 80 cmH₂O three months postoperatively. It was thought that the decreased sphincteral function recovered as a result of reuse of the anus.

Key words
external intestinal fistula, diversion colitis, anorectal manometry

Reprint requests
Yukihiro Funada Department of Surgery, Usa Gastrointestinal Hospital
4092-1, Esuka Usa-city, 872-0032 JAPAN

Accepted
September 16, 1998

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