Fig. 2.

Closure of an enterocutaneous fistula

A. The patient underwent a partial gastrectomy, debridement, and omentopexy for a perforated gastric ulcer. The discharge continued through the drain for 3 months and computed tomography (CT) showed a large cystic lesion containing air (arrow) near the drain and transverse colon. B. Fistulography revealed the splenic flexure of the transverse colon (arrow). C. A fibrin glue injection was performed using two 4-F catheters. D. However, the fistula reopened 8 days after the procedure. CT showed that the cystic lesion was still present (arrow). E. The drainage catheter was re-inserted, and the fibrin glue injection was repeated 15 days later. At that time, two 4-F catheters were advanced into the transverse colon through the fistula and the fibrin glue injection was continued while pulling back the catheters to seal the whole fistulous tract. F. The fistula healed after the second fibrin glue injection. CT performed 3 days after the procedure showed that the cystic lesion had markedly decreased in size (arrow).