USE of Papain and Own Collector Device in Intestine Fistulas in Peritoneostomy: CASE REPORT

USE OF PAPAIN AND OWN COLLECTOR DEVICE IN INTESTINE FISTULAS IN PERITONEOSTOMY: CASE REPORT
tanialima.et@terra.com.br

Lima, T.G.S.; Lemos, V. R.; Santos, V.L.C.G.; Lacombe, D.L.P.; Neto, J.P.A.

Objective: To report the use of papain in small intestinal fistulas in peritoneotomy after informed consent. Introduction: enterocutaneous fistulas represent a major challenge to health professionals and especially for patients who experience many situations of isolation and prolonged hospitalization. The implementation of laparostomy has been recommended since 1979 for the treatment of intra-abdominal infection, allowing ample drainage of secretions removed in addition to facilitating the washing of the peritoneal cavity through planned reoperation. The washing of the abdominal cavity  was done with papain powder diluted in saline. Papain is a proteolytic enzyme extracted from the plant Carica papaya. Papain 2% stimulates granulation tissue, fibroblasts and collagen fibers.
Method: 34, female, born and resident in Rio de Janeiro-RJ. Hospitalized in January with acute gastrointestinal bleeding in large volume. In February, during the colon preparation for colonoscopy, the patient developed abdominal distension, evolving to septic shock and then subjected to total colectomy with terminal ileostomy. Subsequently the patient underwent 38 surgeries in which she had several points of necrosis in the small intestine and then remained in peritoneotomy. The patient underwent several biopsies and so far does not have confirmed diagnosis. Concerning the healing, the patient used the VAC system for 4 months and suspended its use when started using her own collection system and washing with 2% papain two a day. Conclusion: When we started using the papain, the lesion measured 21 cm x 14 cm in diameter and had multiple points of bleeding. Currently, the lesion measures 9.5 cm x 8 cm. The patient is still fed through TPN, pending confirmation of diagnosis and surgical closing of fistulas.

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