Management of Colocutaneous Fistula with Surgical Intervention: A Case Report

Abstract

A colocutaneous fistula is a type of enterocutaneous fistula where communication exists between the colon and the skin of the abdominal wall. The present case report was of postoperative colocutaneous fistula in a 32-year-old male patient, who had undergone left open nephrectomy. This is unique, as nephrectomy is not a procedure that is usually associated with such colocutaneous fistulas, particularly as this was a case of non functioning kidney and was not associated with severe inflammation or adhesions, which are usually prerequisites for a fistula to arise. Following surgery, patient developed feculent discharge from the drain in the early postoperative period. A Contrast Enhanced Computed Tomography (CECT) scan for evaluation of the cause of leak was done, which showed a colocutaneous fistula arising from the proximal descending colon with an abscess surrounding the fistula tract. The abscess was drained and conservative management was initially attempted to allow for spontaneous resolution of the fistula as spontaneous closure is the norm, when there are no unfavourable factors hindering spontaneous closure, as was the case in this patient. However, despite all factors being favourable for spontaneous closure of the fistula, it failed to occur in the present case. Furthermore, this patient required multiple surgical procedures, which is also unusual for a fistula such as this, where all factors being favourable for its spontaneous healing. Closure of the fistula was finally being achieved by resection of the fistula tract along with the segment of the bowel containing the internal opening. The present case report highlighted the challenges posed by cases of colocutaneous fistulas and shows that thorough knowledge of all the treatment modalities available for its treatment, is required to successfully treat it.