Gastrointestinal Fistula: Audit of management in a remote hospital

Abstract

Background: The management of gastrointestinal fistula continues to present considerable challenge to the surgeon in general and gastrointestinal surgeon in particular. Objectives: To audit the management and report the outcome of the gastrointestinal fistula in a remote hospital. Setup: Eldamazeen Hospital is a regional hospital in the Blue Nile state, south east of Sudan. Methods: Retrospective analysis of demographic and clinical data of patients with gastrointestinal fistula admitted to the surgical department in the period from Feb 2003 through Feb 2008. Results: 10(83.3%) patients had high out-put fistula. Two fistulas were complex and 10 were simple. The small intestine was the commonest site of fistula followed by the large bowel. The commonest causes of the gastrointestinal fistula are emergency operations for stab wounds, laparotomy and caesarean section. The overall mortality rate is 2(16, 7%) patients mainly due to inter-abdominal abscesses. Conclusion: Conservative treatment with nutritional support is the corner stay for successful treatment. However, early surgical management of septic foci should be considered.