Does Phenytoin Improve the Healing of Gastrointestinal Fistulas?

Pancreatic fistulas are among the most devastating complications after pancreatic surgery. Their subsequent development can be lethal. We report two cases of pancreatic fistulas treated with phenytoin. Fistula tract healing consists of several processes, including cell migration and the formation of a new extracellular matrix. Multiple studies have shown that phenytoin can promote wound healing and induce faster fibrosis. We postulate that such a positive effect can be used to enhance fibrosis of the pancreatic fistula tract. We treated two patients who had developed high-output pancreatic fistulas after pancreatic surgery. The first underwent hand-assisted laparoscopic pancreatic necrosectomy and developed two high-output pancreatic fistulas and a colocutaneous fistula. The second occurred post Whipple surgery. Both were given oral phenytoin after failure to respond to other measures. In conclusion, oral phenytoin may have a positive effect in the treatment of fistulas. Prospective studies are needed to indicate this possible effect of phenytoin on fistula healing.