Metabolic and Nutritional Support of the Enterocutaneous Fistula Patient: A Three‐Phase Approach

Polk, Travis M.; Schwab, C. William

doi:10.1007/s00268-011-1315-0

Cited by 93 publications

(120 citation statements)

References 76 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…The preferred route being enteral with its preservation of mucosal integrity over parenteral route due to the inherent risks associated with obtaining access and provision of parenteral nutrition. [17][18] Mortality in the present study was 21.4% (n=9). The significant predictors of mortality in our study were male sex, age >60 years, ECF following emergency surgery, mesenteric vascular ischemia as the underlying pathology, high output fistulae, jejunum as the origin of fistula, serum albumin <2.5g/dl and requirement of resurgery corresponding to literature.…”

Section: Discussionmentioning

confidence: 82%

Clinical study of enterocutaneous fistula

Garale¹,

Takalkar²,

Venkatramani³

2017

Int Surg J

View full text Add to dashboard Cite

Background: An enterocutaneous fistulae (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death.Methods: This descriptive study was conducted prospectively in the Department of Surgery between September 2004 and August 2010. Patients whom develop ECF after surgery were included in the study while patients with esophageal, biliary, pancreatic, and perianal fistulas were excluded. The description of fistula included cause, anatomical location, fistula output, complications, and outcome. Fistula output was quantified by direct measurement, in the presence of drain or by calculating number of dressing pads soaked per day. To examine the statistical significance of association between attributes, Chi-square test and Fisher's exact test were used. A probability value of less than 5% (P < 0.05) was considered significant.Results: A total of 42 patients were included in the study, of which 23 were males and 19 were females and the male:female ratio was 1.2:1. Most patients with ECF were aged 41-50 (mean age, 44.23±2.72). Of the 42 patients, 9 patients had colonic fistula and the remaining had small intestinal fistula; 16 ileal, 5 duodenal, and 12 jejunal. There were 22 patients with high-output fistula as compared to 20 patients with low output fistula. Mortality was significantly higher in patients with males, age >60 years, high-output fistula, mesenteric ischemia as underlying pathology, serum albumin <2.5g/dl and re-surgery.Conclusions: Early diagnosis and stabilization form key aspects of management of ECF as most patients are managed conservatively. Prompt nutritional supplementation alters the outcome of this disease. High output fistulae required mostly surgical management and had high morbidity and mortality.

show abstract

Section: Discussionmentioning

confidence: 82%

Clinical study of enterocutaneous fistula

Garale¹,

Takalkar²,

Venkatramani³

2017

Int Surg J

View full text Add to dashboard Cite

show abstract

“…Another milestone development occurred in the 1990s when Rotondo presented a new concept in traumatology: damage control surgery. With this new philosophy, the issues of the open The use of negative pressure wound therapy (NPWT) in the management of enteroatmospheric fistula abdomen, including a new type of fistula: enteroatmospheric fistula, became more and more common (7,9).…”

Section: Discussionmentioning

confidence: 99%

The Use Of Negative Pressure Wound Therapy (NPWT) In The Management Of Enteroatmospheric Fistula – Case Report And Literature Review

Jaguścik¹,

Walczak²,

Porzeżyńska³

et al. 2015

Polish Journal of Surgery

View full text Add to dashboard Cite

c A S E R E P O R t SAn enteric fistula that occurs in an open abdomen is called an enteroatmospheric fistula (EAF) and is the most challenging complication for a surgical team to deal with. The treatment of EAF requires a multidisciplinary approach. First of all, sepsis has to be managed. Any fluid, electrolyte and metabolic disorders need to be corrected. Oral intake must be stopped and total parenteral nutrition introduced. The control and drainage of the effluent from the fistula is a separate issue. Since there are no fixed algorithms for the treatment of EAF, surgeons need to develop their own, often highly unconventional solutions. We present the case of a 24-year-old man who developed enteroatmospheric fistula after laparotomy and relaparotomy due to acute necrotic pancreatitis. Both the laparostomy and the fistula were successfully managed using modified negative pressure wound therapy. The literature regarding this issue was also reviewed.

show abstract

“…Order laboratory tests and monitor results Consult nutritionist or nutrition support team; order early enteral nutritional feedings if not contraindicated Order and monitor nutrition-related laboratory tests and adjust nutrition orders as necessary Ensure starting point in nutritional support of 1.5-2.5 g/kg per day of protein to achieve a positive nitrogen balance, and follow ongoing measurements of nutritional parameters. 35 Include provision of vitamins and minerals, including zinc and vitamin C, administered at twice the normal recommended daily allowance.…”

Section: Medical Interventionsmentioning

confidence: 99%

“…35,[38][39][40] In a study by Dissanaike et al, 41 rates of ventilator-associated pneumonia were significantly lower in the enterally fed group (43.8%) than in the nonfed group (72.1%), but ICU length of stay, hospital length of stay, and wound or bloodstream infections did not differ significantly between the 2 groups. Collier et al 39 found no statistical significance in rates of bloodstream, wound, or urinary infections and length of ICU or hospital stays between patients who received early enteral feedings and patients who did not.…”

Section: Nutritional and Metabolic Supportmentioning

confidence: 99%

Open Abdomen in Trauma and Critical Care

Fitzpatrick

2017

Critical Care Nurse

View full text Add to dashboard Cite

The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia. Determining the need for this poten- T he open abdomen is a technique with recently expanded implementation in managing complex problems in critically ill patients. First used in trauma care in the 1990s, the technique is now a management strategy for many other illnesses and conditions in critically ill adults. The mainstay of treatment for intra-abdominal infections, intra-abdominal bleeding, and abdominal compartment syndrome (ACS), whatever the cause, is the intentional creation of an open abdomen, which is a laparotomy wound that allows a damaged or edematous viscera to expand, reducing intra-abdominal pressure (IAP) and related complications.1 The technique of the open abdomen is defi ned as intentionally leaving the fascial edges of the abdomen unapproximated (laparostomy) through a surgically created entrance into the cavity. As a result, the abdominal contents are exposed but are protected by a temporary 22

show abstract

Metabolic and Nutritional Support of the Enterocutaneous Fistula Patient: A Three‐Phase Approach

Abstract: Aggressive nutritional therapy is necessary to reverse the catabolic state associated with ECF/EAF patients. Once established, it allows proper time, preparation, and planning for definitive management of the fistula, and in many cases provides the support for spontaneous closure.

Cited by 93 publications

References 76 publications

Clinical study of enterocutaneous fistula

Clinical study of enterocutaneous fistula

The Use Of Negative Pressure Wound Therapy (NPWT) In The Management Of Enteroatmospheric Fistula – Case Report And Literature Review

Open Abdomen in Trauma and Critical Care

Contact Info

Product

Resources

About