Authors: Dorothy Rocourt, MD, FACS1; William Wong, DO2; Danielle Peterson, MD2; 1Penn State Children's Hospital; 2Penn State Health
This is a video demonstrating the take down of an ileocolic fistula. The key elements of this procedure were patient position to allow further evaluation and using a penrose to isolate the fistula. Our patient is a 17 year old male presenting with complaints of severe back and leg pain for 1 week. He had a history of Ulcerative Colitis (UC). A computed tomography (CT) revealed inflammation of the distal colon and a right lateral perirectal fistula communicating with a presacral abscess. Two weeks later, he had a CT guided presacral drain study which showed fistulous communications between the presacral abscesses within the rectum and the distal ileum. He was taken to the operating room for laparoscopic takedown of the fistula and fecal diversion. Postoperatively, he was started on Remicade. Three months later, he had a normal colonoscopy and barium enema. He then had a laparoscopic ileocectomy with primary stapled ileocolic anastomosis. Final pathology was consisted with Crohn’s ileitis.