{"id":4006,"date":"2019-02-19T09:00:40","date_gmt":"2019-02-19T09:00:40","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/drenagem-interna-com-pigtail-no-tratamento-de-fistula-gastrocutanea\/"},"modified":"2022-06-17T14:00:46","modified_gmt":"2022-06-17T14:00:46","slug":"drenagem-interna-com-pigtail-no-tratamento-de-fistula-gastrocutanea","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/drenagem-interna-com-pigtail-no-tratamento-de-fistula-gastrocutanea\/","title":{"rendered":"Drenagem interna com pigtail no tratamento de f\u00edstula gastrocut\u00e2nea"},"content":{"rendered":"<p><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/fistula-gastrocutanea-1.jpg\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" class=\"aligncenter size-full wp-image-9850\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/fistula-gastrocutanea-1.jpg\" alt=\"\" width=\"956\" height=\"262\"><\/a><\/p>\n<p>Paciente do&nbsp;sexo feminino, 57 anos, no p\u00f3s operat\u00f3rio tardio de hepatectomia por colangiocarcinoma. Durante o acompanhamento&nbsp;p\u00f3s operat\u00f3rio evoluiu com carcinomatose peritoneal, ascite e obstru\u00e7\u00e3o biliar&nbsp;tratada com a coloca\u00e7\u00e3o de um stent pl\u00e1stico.<\/p>\n<p>Relata que ha&nbsp;2 meses apresentou cole\u00e7\u00e3o abdominal infectada que foi drenada percutaneamente, evoluindo com f\u00edstula gastrocut\u00e2nea no local da drenagem, que se manteve mesmo ap\u00f3s a remo\u00e7\u00e3o dos drenos. Foi ent\u00e3o encaminhada para avalia\u00e7\u00e3o da possibilidade de terapia endosc\u00f3pica para resolu\u00e7\u00e3o da f\u00edstula.<\/p>\n<p>Na primeira avalia\u00e7\u00e3o&nbsp;a paciente estava est\u00e1vel, sem sinais infecciosos, alimentando-se oralmente mas com alto d\u00e9bito pela f\u00edstula gastrocut\u00e2nea.<\/p>\n<p>A tomografia mostrava uma cole\u00e7\u00e3o anterior ao est\u00f4mago comunicando-se com a pele na regi\u00e3o do flanco direito.&nbsp; Presen\u00e7a de ascite em pequena quantidade e espessamento do perit\u00f4nio e epiplon, compat\u00edveis com carcinomatose. Al\u00e9m disso havia trombose de veia porta com importante circula\u00e7\u00e3o colateral perig\u00e1strica e esof\u00e1gica.<\/p>\n<p><strong>Endoscopia Digestiva Alta<\/strong><\/p>\n<p>A endoscopia demonstrou um orif\u00edcio fistuloso com aproximadamente 15 mm, localizado na parede anterior do antro proximal. No interior da cavidade da f\u00edstula era vis\u00edvel a presen\u00e7a de res\u00edduos alimentares.<\/p>\n<p>&nbsp;<\/p>\n<div id=\"attachment_9752\" style=\"width: 909px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/fistula-gastrocutanea.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" aria-describedby=\"caption-attachment-9752\" class=\"wp-image-9752 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/fistula-gastrocutanea.jpg\" alt=\"\" width=\"899\" height=\"384\"><\/a><p id=\"caption-attachment-9752\" class=\"wp-caption-text\">Orif\u00edcio fistuloso na parede anterior do antro g\u00e1strico proximal com res\u00edduos alimentares no seu interior.<\/p><\/div>\n<p>&nbsp;<\/p>\n<p><strong>Conduta:<\/strong><\/p>\n<p>Foi ent\u00e3o proposto \u00e0 paciente a realiza\u00e7\u00e3o de drenagem interna para tentar fechar a f\u00edstula cut\u00e2nea.<\/p>\n<p>Inicialmente foi realizada uma fistulografia para avaliar o tamanho da cavidade e os trajetos fistulosos.&nbsp; Para isso um bal\u00e3o extrator de 15 mm foi utilizado para obstruir o orif\u00edcio fistuloso&nbsp; e permitir a inje\u00e7\u00e3o de contraste. A fistulografia demonstrou uma cole\u00e7\u00e3o perig\u00e1strica com 6 cm no maior di\u00e2metro e a presen\u00e7a de 3 trajetos fistulosos para a pele.<\/p>\n<div id=\"attachment_9851\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2019\/02\/fistulografia-endoscopica-1.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" aria-describedby=\"caption-attachment-9851\" class=\"wp-image-9851 size-medium\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/fistulografia-endoscopica-1.jpg\" alt=\"\" width=\"300\" height=\"280\"><\/a><p id=\"caption-attachment-9851\" class=\"wp-caption-text\">Fistulografia. Utilizado bal\u00e3o extrator para ocluir o orif\u00edcio e permitir a inje\u00e7\u00e3o de contraste. Nota-se marca met\u00e1lica (agulha) colada na pele para marcar o local do orif\u00edcio g\u00e1strico. Presen\u00e7a de pr\u00f3tese biliar pl\u00e1stica colocada previamente.<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>Ap\u00f3s a delimita\u00e7\u00e3o da f\u00edstula o cateter bal\u00e3o desinsuflado foi introduzido no orif\u00edcio fistuloso e realizada lavagem com soro fisiol\u00f3gico at\u00e9 a sa\u00edda dos res\u00edduos alimentares e do excesso de fibrina.<\/p>\n<p>Depois da limpeza, o fio-guia foi introduzido&nbsp;com aux\u00edlio de um cateter introdutor&nbsp;e uma pr\u00f3tese de duplo pig tail de 7 F por 5 cm foi colocada no interior&nbsp;da cavidade perig\u00e1strica atrav\u00e9s do orif\u00edcio fistuloso.&nbsp;Ap\u00f3s a coloca\u00e7\u00e3o do pigtail uma&nbsp;sonda nasoenteral foi posicionada em posi\u00e7\u00e3o p\u00f3s pil\u00f3rica.<\/p>\n<p>&nbsp;<\/p>\n<div id=\"attachment_9753\" style=\"width: 802px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/pig-tail-radioscopia.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9753\" class=\"wp-image-9753 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/pig-tail-radioscopia.jpg\" alt=\"\" width=\"792\" height=\"256\"><\/a><p id=\"caption-attachment-9753\" class=\"wp-caption-text\">1. Fistulografia. Na imagem nota-se tamb\u00e9m a pr\u00f3tese biliar colocada previamente. 2. Coloca\u00e7\u00e3o do fio guia no interior da cavidade da f\u00edstula. 3. Cateter de duplo pigtail inserido dentro da f\u00edstula e SNE posicionada em posi\u00e7\u00e3o p\u00f3s pil\u00f3rica.<\/p><\/div>\n<p>&nbsp;<\/p>\n<div id=\"attachment_9754\" style=\"width: 814px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/pigtail-fistula-gastrica.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9754\" class=\"wp-image-9754 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/pigtail-fistula-gastrica.jpg\" alt=\"\" width=\"804\" height=\"270\"><\/a><p id=\"caption-attachment-9754\" class=\"wp-caption-text\">Pr\u00f3tese de duplo pigtail colocada no orif\u00edcio fistuloso. Na \u00faltima imagem nota-se a presen\u00e7a da SNE.<\/p><\/div>\n<p><strong>Evolu\u00e7\u00e3o:<\/strong><\/p>\n<p>No dia seguinte ao procedimento o d\u00e9bito da f\u00edstula j\u00e1 reduziu consideravelmente.&nbsp; Foi liberada dieta l\u00edquida sem res\u00edduos via oral e iniciada a dieta enteral.&nbsp; A paciente recebeu alta no segundo dia ap\u00f3s a realiza\u00e7\u00e3o do procedimento.<\/p>\n<p>Dez dias ap\u00f3s a drenagem interna as f\u00edstulas cut\u00e2neas fecharam.&nbsp; A SNE foi removida e dieta de consist\u00eancia pastosa iniciada. A pr\u00f3tese de pigtail foi mantida em posi\u00e7\u00e3o.<\/p>\n<p>&nbsp;<\/p>\n<div id=\"attachment_9751\" style=\"width: 567px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/fistula-cicatrizada.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-9751\" class=\"wp-image-9751 size-full\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/fistula-cicatrizada.jpg\" alt=\"\" width=\"557\" height=\"240\"><\/a><p id=\"caption-attachment-9751\" class=\"wp-caption-text\">1. Dois orif\u00edcios fistulosos cut\u00e2neos abertos. 2. Dez dias ap\u00f3s o procedimento. Parada completa da drenagem pelas fistulas e cicatriza\u00e7\u00e3o dos orif\u00edcios.<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>No momento a paciente est\u00e1 h\u00e1 mais de 60 dias do procedimento, alimentando-se oralmente e sem recidiva das f\u00edstulas cut\u00e2neas.<\/p>\n<p><strong>Discuss\u00e3o<\/strong><\/p>\n<p>Deisc\u00eancias e f\u00edstulas ap\u00f3s cirurgias gastrointestinais s\u00e3o geralmente tratadas de forma minimamente invasiva atrav\u00e9s de drenagem cir\u00fargica ou percut\u00e2nea, desvio do tr\u00e2nsito alimentar e oclus\u00e3o utilizando dispositivos endosc\u00f3picos. V\u00e1rios tratamentos endosc\u00f3picos foram propostos com este objetivo.&nbsp; Os mais comuns incluem o uso de pr\u00f3teses met\u00e1licas recobertas, clipes, plugues, colas e terapia a v\u00e1cuo.<\/p>\n<p>Por\u00e9m, mesmo quando a coloca\u00e7\u00e3o de uma pr\u00f3tese met\u00e1lica recoberta \u00e9 poss\u00edvel anatomicamente, a drenagem interna (com uso de pr\u00f3teses pl\u00e1sticas de duplo pigtail) pode ser oferecido como primeira linha de tratamento em f\u00edstulas mais tardias.&nbsp; Nestas situa\u00e7\u00f5es a drenagem interna pode evitar a necessidade de repetidas drenagens percut\u00e2neas ou cir\u00fargicas e tamb\u00e9m reduzir a necessidade de m\u00faltiplas reabordagens endosc\u00f3picas.<\/p>\n<p>Al\u00e9m disso, a drenagem interna com pigtail&nbsp;pode ser utilizada como terapia de resgate nas f\u00edstulas que se mant\u00e9m ap\u00f3s o tratamento com pr\u00f3teses met\u00e1licas recobertas.<\/p>\n<p>Nas f\u00edstulas a pr\u00f3tese melhora a drenagem interna favorecendo&nbsp;o retorno da secre\u00e7\u00e3o coletada para o \u00f3rg\u00e3o, consequentemente reduzindo o d\u00e9bito do trajeto cut\u00e2neo, facilitando o seu fechamento.&nbsp; A presen\u00e7a da pr\u00f3tese tamb\u00e9m age como um corpo estranho na cavidade e nas bordas do orif\u00edcio fistuloso causando escarifica\u00e7\u00e3o e promovendo a reepiteliza\u00e7\u00e3o.<\/p>\n<p><strong>Refer\u00eancias<\/strong><\/p>\n<p>Gianfranco Donatelli, Jean-Loup Dumont, Fabrizio Cereatti, Parag Dhumane, Thierry Tuszynski, Bertrand Marie Vergeau, Bruno Meduri. Endoscopicinternaldrainageasfirst-linetreatmentfor fistula following gastrointestinal surgery: a case series. Endoscopy International Open 2016<\/p>\n<p>Donatelli G, Dumont JL, Cereatti F et al. Treatment of leaks following sleeve gastrectomy by endoscopic internal drainage (EID). Obes Surg 2015;<\/p>\n<p>Lemmers A, Tan DM, Ibrahim M et al. Transluminal or percutaneous endoscopic drainage and debridement of abscesses after bariatric surgery:a case series. ObesSurg 2015; 25: 2190\u20132219<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Paciente do&nbsp;sexo feminino, 57 anos, no p\u00f3s operat\u00f3rio tardio de hepatectomia por colangiocarcinoma. Durante&hellip;<\/p>\n","protected":false},"author":2464,"featured_media":4007,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[145],"tipo":[153],"volume":[263],"class_list":["post-4006","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-145","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Drenagem interna com pigtail no tratamento de f\u00edstula gastrocut\u00e2nea &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/drenagem-interna-com-pigtail-no-tratamento-de-fistula-gastrocutanea\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Drenagem interna com pigtail no tratamento de f\u00edstula gastrocut\u00e2nea\" \/>\n<meta property=\"og:description\" content=\"Paciente do&nbsp;sexo feminino, 57 anos, no p\u00f3s operat\u00f3rio tardio de hepatectomia por colangiocarcinoma. 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