Evaluation and Management of Post-Operative Enterocutaneous Fistula

Abstract

Background: An enterocutaneous fistula is the abnormal communication between two epithelialized surfaces, one of which is a hallow organ. The discharge of intestinal content into the skin constitutes major nursing challenge. The most important complications include infection and sepsis, electrolyte imbalances and malnutrition, which when not managed properly will lead to grave outcome. Aims: To evaluate the causative factors, the various modes of management and the outcome of such intervention. Methods: Retrospective study of the patients admitted and treated for enterocutaneous fistula due to operative causes were evaluated in Dept of General Surgery S.C.B. Medical College and Hospital, Cuttack from 2014 to 2016. Results: Enterocutaneous fistula frequently follow emergency surgery on gastrointestinal tract, particularly the ileum, duodenum and colon, usually occurring around the 7th postoperative day and most end in spontaneous closure with conservative therapy. Surgery should be restricted to treatment of specially indicated patients like prolonged continuous fistulous discharge, abdominal wound dehiscence and deep seated intra peritoneal abscess. Conclusions: The total management of enterocutaneous fistula involves skilled nutritional support, stoma therapy, elimination of sepsis and finally a carefully timed, well-judged and well carried out surgery which will result in favourable outcome in patients with this dreaded complication.

Postoperative Enterocutaneous Fistula: A Severe and Desperate Complication in a Disadvantaged Surgical Setting

“…Enterocutaneous fistula whether spontaneous or postoperative, is a desperate event in the abdominal surgical setting. The overall incidence of postoperative fistulas is difficult to elucidate because in the literature, most studies are based on series of clinical observations [2][3][4][5][6]. During a period of three years, we recorded 69 cases of postoperative enterocutaneous fistulas representing 14.68% of all postoperative abdominal complications in the department.…”

“…During a period of three years, we recorded 69 cases of postoperative enterocutaneous fistulas representing 14.68% of all postoperative abdominal complications in the department. In UK, Hollington P et al [11] reported 277 consecutive enterocutaneous fistula over an 11 years period in a major tertiary referral center; while in India, Mohanty SK et al [6] noted 30 cases in two years. This difference of cases numbers could be explained by the method of recruitment but also by the level of the health structure concerned.…”

“…Re-intervention to heal the fistula is often indicated in situations of high output, persistence of the fistula, intraabdominal sepsis or associated evisceration [2][3][4][5][6]12]. The best time to perform this surgical procedure remains controversial.…”

“…Digestive or gastrointestinal fistula is one of the most feared postoperative complication along with dehiscence and infection [1]. It is a dreaded complication quite common in abdominal, digestive, gynecological or urological surgery [1][2][3][4][5][6]. They generally affect fragile subjects who have undergone multiple operations, in poor general condition, often elderly with comorbidities, which makes their management difficult.…”

“…They generally affect fragile subjects who have undergone multiple operations, in poor general condition, often elderly with comorbidities, which makes their management difficult. The overall incidence of postoperative enterocutaneous fistulas is hard to determine because in the literature, most publications concern the study of clinical observations [2][3][4][5][6]. Although the morbidity and mortality associated with enterocutaneous fistulas have decreased over the past 50 years with the progress in resuscitation and treatment modalities, the overall mortality is still surprisingly high ranging from 6.5 to 39% [7][8][9][10] in the literature.…”