Endoscopic diagnosis and treatment of a pyriform sinus-cutaneous fistula in a non-pediatric patient: thinking outside the box

Background and Aims

Pyriform sinus-cutaneous fistula is often observed in pediatric patients and is very rare in adults. Diagnosing this condition in adults is challenging, and contrast-enhanced CT misdiagnosis is not uncommon. Neck abscess formation secondary to this fistula is treated with surgical incision and drainage, but recurrence can occur due to the fistula. Although surgery is the most effective treatment modality, less-invasive therapies such as electrocauterization or chemocauterization may be indicated. However, treatment with these cauterization techniques has a high treatment failure rate.

Methods

This is the first case report of diagnosing, by EGD, a pyriform sinus fistula in an adult treated with autologous abdominal fat transplantation associated with adjunctive conventional endoscopic therapies.

Results

A 35-year-old woman with a history of 2 cervical abscesses was admitted due to a recurrent abscess with unknown etiology. She underwent surgical drainage with intraoperative EGD under fluoroscopic assistance, and a pyriform sinus-cutaneous fistula was diagnosed. Subsequently, fistula treatment with unprocessed autologous adipose abdominal tissue collected by lipoaspiration associated with argon plasma coagulation and endoscopic vacuum therapy were successfully performed. Immediately after the procedure, the patient no longer experienced fluid discharge through the skin. The patient had no recurrence within 10 months of follow-up.

Conclusions

Autologous abdominal fat transplantation may be an effective minimally invasive therapy for pyriform sinus-cutaneous fistula and has the potential to become an alternative therapy for GI fistulas. We encourage future studies to exploit the role of this therapy for GI fistulas.