PMC5407358_01
Computed tomography scan of the Y-shaped fistula between pouch lumen and skin. The dotted line indicates the pouch-to-pouch fistula that was later treated with endoscopic fistulotomy. The solid line indicates the cutaneous fistula linked to the pouch-to-pouch fistula.
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F1
The patient remained well for 2 years, but he subsequently developed a complex Y-shaped fistula that connected the skin surface to the tip of his J pouch and the pouch inlet (Figure 1).
Endoscopic images of (A) the removal of the dislodged over-the-scope clip, (B) the flexible tip guidewire probing the pouch-to-pouch fistula tract, (C) fistulotomy using a needle knife on the ERBE spray setting, and (D) hemoclips placed after the pouch-to-pouch fistulotomy.
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F2
When he returned for repeat pouchoscopy 2 weeks later, both OTSCs were found to be dislodged, and so they were removed (Figure 2). A flexible soft-tip guidewire was used to probe the fistula tract from the pouch inlet to the tip of the "J" (Figure 2). Scientific, Natick, MA) with ERBE electrocauterization (ERBE USA Incorporated, Marietta, GA) on the spray setting to cut through the full thickness of the septum of the proximal pouch to the channel of the pouch-to-pouch fistula (Figure 2). Some purulent fluid was seen draining from the incised area. Hemoclips (Cook Medical, Bloomington, IN) were placed along the mucosal surface of the cut to prevent it from forming another tract as it healed (Figure 2).
(A) Endoscopic image of the healed fistula two weeks after endoscopic fistulotomy. (B) Healed enterocutaneous fistula on the abdomen.
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F3
Examination of his abdomen showed that the enterocutaneous fistula had also healed (Figure 3).