Experience of living with an enterocutaneous fistula

Härle, Karolina; Lindgren, Margareta; Hallböök, Olof

doi:10.1111/jocn.12857

Cited by 8 publications

(12 citation statements)

References 18 publications

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“…ECFs are a significant complication of major abdominal surgery, which remain a significant therapeutic challenge despite modern advances. They are associated with significant rates of mortality, in addition to restriction to activities of daily living and mental health [1]. Therapeutic strategies are based around patient optimization, nutrition, and control of sepsis in order to promote spontaneous closure.…”

Section: Discussionmentioning

confidence: 99%

Successful radiological embolization of a low output jejunal enterocutaneous fistula using a cyanoacrylate and lipiodol mixture

Nasralla¹,

Fahad²

2019

Radiology Case Reports

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Enterocutaneous fistulas (ECFs) are a significant complication of abdominal surgery which present a significant therapeutic challenge for clinicians. Definitive surgical treatment of these fistulas is not without significant risk, which both patients and clinicians would seek to avoid. We present a case of successful treatment of a low output jejunal ECF by percutaneous embolization using an ethiodized oil and n-butyl-2-cyanoacrylate glue mixture in a 40-year-old man who developed an ECF after inadvertent jejunostomy tube removal. This case demonstrates the technique and suitability of a widely available embolic agent for treatment of proximal small bowel ECFs. In addition, the case illustrates the potential of minimally invasive interventional radiological procedures in the management of ECFs, particularly in high-risk patients, as an alternative to surgery.

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Section: Discussionmentioning

confidence: 99%

Successful radiological embolization of a low output jejunal enterocutaneous fistula using a cyanoacrylate and lipiodol mixture

Nasralla¹,

Fahad²

2019

Radiology Case Reports

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“…21 IF resulting from high-output fistulae is a serious complication and can significantly impact morbidity, mortality, and quality of life of these patients. 22,23 IF is defined as the inability of the gut to absorb sufficient macronutrients, micronutrients, or fluid, resulting in the need for intravenous (IV) supplementation to maintain health or facilitate growth. 24 IF is usually differentiated into 3 categories.…”

Section: Overview Of High-output Fistulaementioning

confidence: 99%

Nutrition Management of the High‐Output Fistulae

et al. 2020

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Enterocutaneous fistulae (ECFs) are commonly encountered complications in medical and surgical practice. High-output fistulae are associated with significant morbidity and mortality, poor quality of life, and a substantial healthcare burden. An interdisciplinary team approach is crucial to prevent and mitigate the adverse clinical consequences of high-output ECFs including sepsis, metabolic derangements, and malnutrition. Patients with ECFs are at a significantly higher risk of developing malnutrition and close monitoring by nutrition support professionals and/or a nutrition support team is an essential component of their medical management. High-output ECFs often require the initiation of nutrition support through either enteral or parenteral routes. Historically, parenteral nutrition (PN) has been the primary method of nutrition support in these patients. However, oral and enteral nutrition (EN) should remain viable options if an evaluation of the location of the ECF, amount of remaining functional bowel, and volume of ECF output identifies favorable conditions. Additionally, in contrast to PN, oral nutrition and EN are the preferred method of feeding because of the maintenance of the structural and functional integrity of the gastrointestinal tract. The inclusion of pharmacological interventions can greatly assist with the reduction and stabilization of ECF output and thereby permit sustained enteral feeding. Initiation of supplemental or full PN will be required if oral nutrition and EN lead to metabolic derangements, fail to meet energy requirements, or do not maintain or improve the patient's nutrition status. The main focus of this review is to discuss the nutrition management of patients with high-output ECFs.

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“…Patients find themselves isolated, living in fear of appliance leak, physically hungry, angry, and depressed. 29 Positive coping mechanisms involve teaching both the patient and his/her family members dressing changes to achieve greater independence, setting goals for daily physical activity, and involving family members at every step of the way. 29…”

Section: Support Of Patient and Familymentioning

confidence: 99%

Enterocutaneous Fistula: Proven Strategies and Updates

Gribovskaja‐Rupp

Melton

2016

Clinics in Colon and Rectal Surgery

117

129

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An enterocutaneous fistula (ECF) is an aberrant connection between the intra-abdominal gastrointestinal (GI) tract and skin/wound. Because of differences in management and significant preponderance of small intestinal and colonic fistulae, fistulae originating in the rectum, upper GI tract, or pancreas will not be discussed in this article.There are several ways in which ECF has been classified, including by output, etiology, and source.1-3 Most often, a high-output ECF is characterized as one with >500 mL/24 hours, low output <200 mL/24 hours, and a moderate output fistula between 200 and 500 mL/24 hours. While the great majority of ECFs are iatrogenic (75-85%), between 15 and 25% occur spontaneously. 3 Common causes of iatrogenic ECF are trauma; operations for malignancy, associated with extensive adhesiolysis, or in the setting of inflammatory bowel disease (IBD); and trauma. 1 With respect to postoperative small bowel fistulae, about half are from an anastomotic leak, with the other half occurring from inadvertent injury to the small bowel during dissection.3 Spontaneous fistulae occur from IBD (most common), malignancy, appendicitis, diverticulitis, radiation, tuberculosis/actinomycosis, and ischemia. 3Organ of origin is another classification used for ECF and is useful as well in the consideration of management options: type I (abdominal, esophageal, gastroduodenal), type II (small bowel), type III (large bowel), and type IV (enteroatmospheric, regardless of origin). 2Closure rates without operative intervention in the era of advanced wound care and parenteral nutrition (PN) vary considerably in reports 19 to 92%, 4,5 with most studies demonstrating closure rates in the 20 to 30% range. 5-11With historical wound care measures, 90% of spontaneous closure occurred in the first month after sepsis resolution, with an additional 10% closing in the second month, and none closing spontaneously after 2 months. 10 With vacuum assisted closure (VAC) and other negative pressure wound therapies (NPWT) therapy, there are case reports of fistulae closure well into the second and third month. ►Table 1 cites favorable and unfavorable prognostic factors for spontaneous fistula closure. 3,4,6,8,[12][13][14] Mortality rates in different series for patients with ECF are also markedly variable in distribution (5.5-33%), 4,7,15 with most deaths attributable to sepsis, malnutrition, and fluid/ electrolyte disturbances. 4,6,7,15,16 Factors that are predictive of high mortality are infectious and noninfectious complications, high-output fistula, 1,8,15,17 and age. 18 Cost of fistula care is significant and typically more than $500,000. 19 Approach to Enterocutaneous FistulaA common acronym used to describe ECF care protocol is "SNAP," which stands for management of skin and sepsis, nutrition, definition of fistula anatomy, and proposing a Keywords ► enterocutaneous fistula ► enteroatmospheric fistula ► spontaneous closure ► mortality ► timeline AbstractManagement of enterocutaneous fistula represents one of the most protracted and...

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Experience of living with an enterocutaneous fistula

Abstract: The competence of health care professionals is essential in the care of patients with an enterocutaneous fistula.

Cited by 8 publications

References 18 publications

Successful radiological embolization of a low output jejunal enterocutaneous fistula using a cyanoacrylate and lipiodol mixture

Successful radiological embolization of a low output jejunal enterocutaneous fistula using a cyanoacrylate and lipiodol mixture

Nutrition Management of the High‐Output Fistulae

Enterocutaneous Fistula: Proven Strategies and Updates

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