Dear Jim
it is a rough road for you and your wife. You are doing all the right things.
best wishes
My wife has resumed TPN and Lipids. She remains NPO. Her PET/CT scans show increased tumor activity in many areas. One such area is where the original serous tumor was excised. So it is most probable that cancer cells are in and around the fistula. The surgeon made no reference to the margins. The serous tumor was removed intact and sent for pathology. Those path results shows the same cell type that was first recognized in 1995. There is definitely cancer throughout her abdomen/peritoneal and other areas. I speculate that the taxol she received 3 days prior to the return of the fistula may have been the cause and effect. I plan on arranging a consultation with a GI specialist at the University of Arizona, Tucson. I've read about the double balloon enteroscopy procedure and am hopeful that it could be used. Thank you Dr. Goodman for your interest and reply
Sincerely
Jim
Dear Jim
the classic management of an intestinal fistula is to divert the bowel with an ileostomy to allow healing of the site. With the fistula being so high in the small intestine , that is not feasible because she would not be able to get enough nutrition with a jejunostomy. Another surgical option is a bypass around the fistula.
The other option is to stop eating and go on IV nutrition to reduce bowel contents.
However, my main concern for your wife would be the possibility that there is cancer in this fistulous tract. That could be a reason for the fistula coming back.
You should ask her doctors about that possibility. What does her scan show? what was the pathology from the surgical excision? Were the margins negative?
If there is cancer in the fistula, it will not heal without surgical excision.
It might be useful to also get a consultation with a colorectal surgeon and a nutritionist.
please let us know what happens
best wishes