Management of an extrasphincteric fistula in an HIV-positive patient by using fibrin glue: a case report with tips and tricks

BMC Gastroenterology

Case Report

Panagiotis Kollaras¹  Dimitra Charpidou²  Isaak Kesisoglou²  Ioannis Pliakos²  Spiros T Papavramidis²  Konstantinos Sapalidis²  Theodossis S Papavramidis²  George Petalotis³ 

[1] 1st Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece;3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece;Department of Radiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece;

关键词: Fibrin Glue;    Fistula Tract;    Anal Incontinence;    Anal Fistula;    Complex Fistula;   

DOI  :  10.1186/1471-230X-10-18

 received in 2009-07-11, accepted in 2010-02-14,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundIndividuals with impaired immunity are at higher risk of perianal diseases. Concerning complex anal fistulas impaired healing and complication rates are also higher. Definitive treatment of a fistula aims controlling the purulent discharge and prevents its recurrence. It depends mainly on the trajectory of the fistula and the underlying disease.We present a case of a HIV-positive patient with a complex extrasphincteric anal fistula who was treated successfully with fibrin glue application. We further, discuss tips and tricks when applying fibrin glue as plugging material in complex anal fistulas.Case presentationA sixty-one-year-old HIV-positive male referred to us for warts and extrasphincteric fistula. Because of the patients' immunological status, we opted against surgery and recommended fibrin glue plugging. The patient was discharged the same day. A follow-up examination was performed 5 days after the initial fibrin glue application showing that the fistula canal was obstructed. Three months and a year post-intervention the fistula tract remains closed.ConclusionThe best treatment for a disease gives at least the same result with the other treatments with minimised risk for the life of the patient and minimal application effort. Conservative closure of fistula with fibrin plugging is simple, safe and with less morbidity than surgery. Our patient was successfully treated without endangering his life despite his precarious medical state. Not everybody believes in the effectiveness of fibrin glue application, however we consider this solution in cases of complex fistulas at least as primary procedure in special populations such as the immunosupressed.

【 授权许可】

CC BY   
© Papavramidis et al; licensee BioMed Central Ltd. 2010