Recently, the Department of Gastrointestinal Surgery II and multiple departments at the Second Hospital of Shandong University successfully treated a critically ill patient with a complex high small intestinal anastomotic fistula. Currently, the patient is recovering well and has been discharged smoothly.

The patient, a 73-year-old elderly female, had undergone local hospital treatment for "small intestinal diverticulum perforation," including intestinal resection and anastomosis. Due to the severity of her condition, she was transferred to the Intensive Care Unit of Shandong University Second Hospital on the 5th day post-operation. The patient experienced recurrent high fever and daily drainage of approximately 800ml of digestive fluid through the drainage tube. Despite various antibiotics and drainage treatments, her condition continued to deteriorate. After careful analysis of the situation and CT scans, the team led by Director Wang Peilin from the Department of Gastrointestinal Surgery suspected the presence of an anastomotic fistula. Recognizing that without addressing the "intestinal fistula," infection and cardiorespiratory function could not be corrected, and with the patient's right internal carotid artery nearly occluded, combined with severe cardiorespiratory and cerebral dysfunction, this became the greatest obstacle to surgery, putting the patient on the brink of life and death.

Through collaboration between the Department of Gastrointestinal Surgery and the Intensive Care Unit, with support from multiple disciplines including Anesthesiology II, Interventional Radiology, Cardiovascular Internal Medicine, Neurology, and the Second Surgical Department, a thorough assessment of surgical risks and the development of a response plan were conducted. On July 19th, Associate Chief Physician Li Guanghua, along with physicians Zhang Jing and Li Zengxian, performed the surgical treatment on the patient under general anesthesia. During the operation, multiple abdominal abscesses and severe infections were discovered. The original anastomotic site was less than 15cm from the ligament of Treitz, and localized poor healing was observed. A fistula was identified. After nearly four hours of surgery, the abscess was successfully cleared, the original anastomotic site was resected, and the small intestine was re-anastomosed. Postoperatively, under the protection and support of the Intensive Care Unit and related departments, the patient went through dark times of respiratory arrest, septicemia, and multi-organ dysfunction, teetering on the edge of life. After aggressive rescue efforts, the patient's condition eventually stabilized, and she was successfully discharged from the Department of Gastrointestinal Surgery II.

Intestinal fistula, especially high small intestinal fistula (within 100cm from the ligament of Treitz), is one of the most challenging diseases in abdominal surgery. The large loss of digestive fluid, mixed with bile and pancreatic juice, is highly corrosive and can cause severe infections. The resulting sepsis, malnutrition, and electrolyte imbalance are the main causes of death, resulting in a high mortality rate. Reoperation is difficult and associated with numerous complications, contributing to a high mortality rate. It has always been a challenging issue in the field of surgery.

In recent years, the Department of Gastrointestinal Surgery II at the Second Hospital of Shandong University has not only developed mature minimally invasive treatments for gastrointestinal diseases such as gastric cancer, small intestinal tumors, and colorectal cancer, but also has been at the forefront in the treatment of abdominal critical and severe cases within the province. The successful treatment of this patient indicates that the department's diagnosis and treatment of complex and difficult diseases like intestinal fistulas have reached a leading level in China.