Enterocutaneous fistulas: an overview

Abstract

Enterocutaneous fistulas remain a difficult management problem. The basis of management centers on the prevention and treatment of sepsis, control of fistula effluent, and fluid and nutritional support. Early surgery should be limited to abscess drainage and proximal defunctioning stoma formation. Definitive procedures for a persistent fistula are indicated in the late postoperative period, with resection of the fistula segment and reanastomosis of healthy bowel. Even more complex are the enteroatmospheric fistulas in the open abdomen. These enteric fistulas require the highest level of multidisciplinary approach for optimal outcomes.

Management of postoperative enterocutaneous fistulae in children: A decade experience in a single centre

“…Although FF may require surgical interventions, re-operation or the use of techniques such as exteriorisation of bowel and parenteral nutrition, emergency resuscitation to ensure normovolaemia and optimised oxygen delivery in anaemic patients should receive priority. [25] Further interventions should focus on control of infection, improvement of nutrition and performing meticulous procedures with sound surgical practice. Preoperatively, nutritional assessment, particularly in patients with a recent 10-15% weight loss, albumin of less than 3.0 g/dl, or low transferrin or total lymphocyte levels (although this is less well proven), who are at increased risk for poor healing and possible anastomotic dehiscence, is also important.…”

Nutritional management of enterocutaneous fistula: a retrospective study at a Malaysian university medical center

“…The cases were managed conservatively, as recommended by the published studies on management of fistula,4,7,10,22 with the exception of one case that was treated surgically. Conservative treatment was used to build up nutritional status, stabilize the patient before surgery, improve the surgical outcome, and decrease the risk of postoperative complications 11.…”

“…It includes total parenteral nutrition (TPN), enteral feeding, or oral feeding, and plays a major role in management of enterocutaneous fistula 8–10. It begins with calculating calories and protein requirements, assessing tolerance of the feeding regimen, modifying feeding methods, adjusting nutritional requirements according to changes in clinical status, and finally, observing for feeding complications 11.…”

The Role of Undifferentiated Dysplasia of the Connective Tissue in the Development of the Enterocutaneous Fistula

“…Згідно з даними літератури тонкокишкові нориці відкриваються у вільну черевну порожнину у 29-32 %, через порожнину гнійника відкриваються в 24,3 % випадків, через евентеровану рану -9,3 % [5]. Летальність при розвитку кишкових нориць в ранньому післяопераційному періоді складає 16,5-57,5 %, а в гострому періоді (несформовані кишкові нориці) -20,0-80,0 %, при високих тонкокишкових норицях -82-90 % [6].…”

“…Основні причини смерті: прогресуючий перитоніт, сепсис, інтоксикація, синдром мальнутриції, водноелектролітні порушення, печінково-ниркова недостатність, кишкова недостатність [7]. Незважаючи на вдосконалення харчової та метаболічної підтримки, антимікробній терапії, поліпшенню догляду за ранами та вдосконаленні операційної техніки рівень летальності при цьому ускладенні залишається вкрай високим [3,5].…”