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| jejunum strongly adharant to sigmoid colon due to internal fistulization |
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| internal fistula |
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| fistula separated |
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| colonic opening confirmed by feeding tube entering to the colonic lumen after the separation of jejunum |
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| colonoscopy confirmed enterocolic fistula pre op |
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| ct scan confirmation of oral contrast entering from jejunum to sigmoid colon |
a case of 45 yr old male having h/o blunt trauma 6 wks back,pt was diagnosed small bowel perforation with peritonitis after 7-8 days of trauma. he was operated in periphery by a senior surgeon who did laparotomy in 7-8 days old bad peritonitis. according to his view, pt was having about 1.5 liter of pus with bilious and fecal peritonitis,he gave lavage and did a proximal ileostomy from a site upto which he was able to trace normal bowel. pt went into septic shock and shifted to surat was on ventilator for 5 days, recovered. pt was planned for ileostomy closure after about 5 weeks of first surgery. pre op evaluation suggested jejuno-colic internal fistulization confirmed on ct scan and colonoscopy. exploratory laparotomy was done, jejunocolic fistula was noted, seperated dirty granulation removed. colonic opening confirmed with feeding tube ,closed in two layers with silk 2.0.jejunal loop separated from colon was excised resection anasotmosis done, ileostomy was closed , which was distal to the jajunal resection-anastomosis site. mass closure of abdomen done.post op, pt recovery was uneventful. discharged on 7 the post op day, now after 1 month pt is absolutely fine. still we all are trying to find the actual cause for internal fistulization,biopsy has not shown any signs of chrohn's disease, no diverticulitis disease of colon.at present probably primary traumatic jejunocolic fistula is the diagnosis.please comment.... case done by me, dr dhaval patel and anesthetist team of baps hospital.
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