The gastrointestinal breach: understanding enterocutaneous fistula

Abstract

The term "fistula" usually refers to abnormal communication between two epithelial surfaces and an enterocutaneous fistula (ECF) is an abnormal communication between any part of gastrointestinal (GI) tract and skin and lined by epithelium or granulation tissue. Common causes include trauma during abdominal surgery, inflammatory bowel disease, malignancy, infection, radiation etc. Sepsis and malnutrition are the leading causes of mortality. In cases of high-output fistula, it is essential to adequately replace the excessive fistula discharge. The patient's nutrition plays a crucial role in the successful management of ECFs. If the patient can tolerate oral or enteral feeding, it should be initiated promptly. However, if oral intake is not feasible, parenteral nutrition should be considered. Adequate wound care, including diligent skincare and timely drainage of localized abscesses, is necessary. Before conducting definitive investigations and initiating treatment, it is important to ensure proper resuscitation and stabilization of the patients. Surgical intervention should be approached in staged manner and should not be rushed to prevent failure in managing this complex condition. To conclude management of ECF is complicated and needs multidisciplinary approach. Initial focus for remedy is on treating fluid and electrolyte disturbances, comprehensive treatment of sepsis, management of fistula output, skin care and psychological support.

Exploration of critical care nurses' challenges in caring for enterocutaneous fistula as a complication for an open abdomen: A qualitative study

“…Applying the stoma bag over the fistula becomes difficult. 9 The leakages of intestinal juice from the digestive tract to the skin result in excoriation, and 30% of patients with ECF develop pressure injuries. Infrequent repositioning due to many stomas or drainage tubes contributes to pressure injuries.…”

“…The enteric contents become problematic when more fluid than solid comes from the enterocutaneous fistula. Applying the stoma bag over the fistula becomes difficult 9 . The leakages of intestinal juice from the digestive tract to the skin result in excoriation, and 30% of patients with ECF develop pressure injuries.…”

“…High output fistula poses significant challenges and demands for critical care nurses (CCNs) in the ICU, resulting in leakages of stomach contents, skin excoriation, and difficulty in stoma bags sticking on the skin. 4 , 9 …”

“…The low‐output fistula drains less than 200 mL/day, the medium‐output fistula drains between 200 and 500 mL/day, and the high‐output fistula drains an excess of 500 mL/day. High output fistula poses significant challenges and demands for critical care nurses (CCNs) in the ICU, resulting in leakages of stomach contents, skin excoriation, and difficulty in stoma bags sticking on the skin 4,9 …”

“…High output fistula poses significant challenges and demands for critical care nurses (CCNs) in the ICU, resulting in leakages of stomach contents, skin excoriation, and difficulty in stoma bags sticking on the skin. 4,9 The complexity of ECF complications demands a multi-disciplinary team approach. 10 A triad of complications poses challenges for CCNs, including fluid and electrolyte abnormalities, sepsis, and malnutrition.…”