Small bowel enterocutaneous fistulae: the merits of early surgery

Gupta, Manoj; Sonar, Pankaj; Kakodkar, Rahul; Kumaran, Vinay; Mohanka, Ravi; Soin, Aravinder; S, Nundy

doi:10.1007/s12262-008-0087-8

Cited by 7 publications

(10 citation statements)

References 27 publications

(26 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…14 Ugochukwu at Enugu (74.2%) 15 and Dodiyi-Manuel et al (75%) 16 in Southern Nigeria, and Chalya et al (65.6%) 17 in Tanzania, also reported a similar high spontaneous healing rate following enteral feeding. Gupta et al (67%) 18 and Visschers et al (87%) 19 reported similar high healing rates with use of enteral and parenteral feeding. However, some workers have reported lower healing rates.…”

Section: Discussionmentioning

confidence: 80%

Experience with enterocutaneous fistula management in a district hospital in Nigeria

Bawa¹,

Sule²,

Grimah³

et al. 2016

East. Cent. Afr. J. Surg.

View full text Add to dashboard Cite

Background: Enterocutaneous fistula (ECF) is an abnormal communication between gastrointestinal tract and skin. It is a difficult condition to treat and morbidity and mortality remain high in many centers. Malnutrition and sepsis are the leading causes of death. There are no clear guidelines for optimal nutritional management. Aggressive measures to maintain positive nitrogen balance is the ultimate goal of nutritional management. Our objective was to review the practice of the nutritional management and outcome of ECF in a resource limited setting in Nigeria. Methods: A retrospective study of all patients with ECF managed between 2006 and 2015. Management included resuscitation, control of sepsis, enteral feeding, skin care and timely surgical intervention. Results: A total of 57 patients were managed. Aetiology of ECF in this study was postoperative in 96.5% of cases. Fistula closure was achieved in 51/57 patients (89.5%). Thirtynine (68.42%) fistulae closed spontaneously on conservative management while 12 (21.05%) fistulae healed following restorative surgery. Mortality rate was 10.5%. Rate of healing was related to serum albumin level and fistula output. Conclusion: Aggressive enteral feeding allows a favorable outcome in enterocutaneous fistula after a convalescence period. High output and hypoalbuminaemia were important prognostic variables.

show abstract

Section: Discussionmentioning

confidence: 80%

Experience with enterocutaneous fistula management in a district hospital in Nigeria

Bawa¹,

Sule²,

Grimah³

et al. 2016

East. Cent. Afr. J. Surg.

View full text Add to dashboard Cite

show abstract

“…This was very much similar to that analysis done by Gupta M Mortality was higher in ≥60 year's group (28.5%) than in <60 years group (8%), but the data was statistically significant (p value-0.1548). 8 Octreotide was used in all cases of high output fistulas and it was found that there was a significant reduction in fistula output within the first 48 hrs. Significant reduction in fistula output after octreotide has also been reported by Paran et al, Sleth et al and Kocak et al [9][10][11] Although somatostatin effectively reduces the fistula output, the rate of spontaneous closure is not changed.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical closure rates were higher than spontaneous closure rates in both populations. 8 Surgical intervention was performed after a median period of 15 days (rage 3-34 days) from the occurrence of the fistula. The goal was to perform surgery as soon as the patient condition was stabilized and any septic and any septic foci had been adequately treated.…”

Section: Discussionmentioning

confidence: 99%

Small bowel enterocutaneous fistulae: is waiting worth?

Kumar

Jauhari

2017

Int J Res Med Sci

View full text Add to dashboard Cite

Background: Enterocutaneous fistula represents a group of complex intraperitoneal infectious processes. Even with recent advances in Para surgical management, critical care and nutritional support, enterocutaneous fistulas remain great challenges to the general surgeon. Mortality remains high largely due to frequent complications of sepsis and malnutrition. Most enterocutaneous fistulas occur following emergency abdominal surgeries and only 15-25% of spontaneous enterocutaneous fistulas are the result of underlying diseases such as Crohn’s diseases, radiation enteritis or diverticular disease. Expectant treatment consisting of octreotide, TPN, and antibiotics waiting for spontaneous closure is associated with high costs, high mortality and prolonged morbidity. In our country, there is need to abandon expectant lines of management for a more aggressive surgical approach once the fluid and electrolyte disturbance and sepsis have been corrected.Methods: The aim of the present study was to audit the result of an aggressive approach in patients with enterocutaneous fistulas and to identify the time of convalescence prior to restorative surgery thereby reducing the morbidity and mortality associated with them. The focus of this study was to determine whether, in patients with fistulae, early intervention resulted in low mortality and morbidity.Results: In the present study, 64 cases of small bowel enterocutaneous fistulas were taken, which were either operated in Patna medical college and hospital or outside in year 2011-13. Majority of patients were <60 years of age. Out of the total population (n=64), 50 patients were <60 years and 14 patients were ≥60 years, with mean age of 46 years (range 17-75 years). The percentage of male population was 56.2 and that of female was 43.8. Mortality was also higher in patients with sepsis, age>60 years and in patients with preoperative albumin below 3.0g/dl (p value>0.05). Early surgical intervention resulted in good patient outcomes as compared to conservative treatment (p value-0.0418). Mortality was higher in patients with foregut fistulae (p value-0.0178) and high output fistulae (p value-0.0309).Conclusions: This study shows that early surgery can result in good patient outcomes. Initial emphasis should be on the treatment of septic foci, aim to improve to patient’s condition. Rather than following a prolonged conservative line of management, surgical repair should be performed when the patient is stable.

show abstract

“…Several factors have already been reported to affect the rate of spontaneous healing, including surgical etiology and low output, with no associated abscess or comorbidity 14. However, a few studies have shown a higher fistula healing rate 16–18. The highest healing rate of 81% was reported by Gupta et al,16 67% was reported by Harriman et al,17 and 53.3% was reported by Nursal Tarık et al18 This difference in reported rates is likely related to the experience and skill of the surgeon or the patient’s condition 14…”

Section: Discussionmentioning

confidence: 99%

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

Badrasawi¹,

Shahar²,

Sagap³

2014

JMDH

View full text Add to dashboard Cite

Enterocutaneous fistula is a challenging clinical condition with serious complications and considerable morbidity and mortality. Early nutritional support has been found to decrease these complications and to improve the clinical outcome. Location of the fistula and physiological status affect the nutrition management plan in terms of feeding route, calories, and protein requirements. This study investigated the nutritional management procedures at the Universiti Kebangsaan Malaysia Medical Center, and attempted to determine factors that affect the clinical outcome. Nutritional management was evaluated retrospectively in 22 patients with enterocutaneous fistula seen over a 5-year period. Medical records were reviewed to obtain data on nutritional status, biochemical indices, and route and tolerance of feeding. Calories and protein requirements are reported and categorized. The results show that surgery was the predominant etiology and low output fistula was the major physiological category; anatomically, the majority were ileocutaneous. The spontaneous healing rate was 14%, the total healing rate was 45%, and the mortality rate was 22%, with 14% due to fistula-associated complications. There was a significant relationship between body mass index/serum albumin levels and fistula healing; these parameters also had a significant relationship with mortality. Glutamine was used in 50% of cases; however, there was no significant relationship with fistula healing or mortality rate. The nutritional status of the patient has an important impact on the clinical outcome. Conservative management that includes nutrition support is very important in order to improve nutritional status before surgical repair of the fistula.

show abstract

Small bowel enterocutaneous fistulae: the merits of early surgery

Cited by 7 publications

References 27 publications

Experience with enterocutaneous fistula management in a district hospital in Nigeria

Experience with enterocutaneous fistula management in a district hospital in Nigeria

Small bowel enterocutaneous fistulae: is waiting worth?

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

Contact Info

Product

Resources

About