Enterocutaneous fistulas (ECF) are serious complications
associated with high morbidity and mortality. Most ECF occurs after surgery
or trauma, while other times Crohn's disease, necrotizing enterocolitis,
intra-abdominal abscess, malignant disease and radiotherapy are the culprits.
ECF can be classified as low output (less than five ml/kg/day), or high
output (greater than five ml/kg/day). Postoperative ECF results from infection
and breakdown of an anastomosis, bowel injury, deserosalization of bowel,
suture-lines defects, tight sutures with ischemic necrosis, injury to mesenteric
vessels, poor hemostasis, adhesive ischemia, volvulus and bowel loop caught
in a fascial suture. Postoperative ECF can be also classified as early
(those that occur within 48 hours after surgery and are associated to a
technical error), and late (occurring 48 hours after the procedure) and
associated with low ischemia time. It is vital to identify the source and
route of the ECF tract by imaging techniques (UGIS, Barium enema, CT Scan
or MRI) and whether the patient has distal obstruction. Management consists
of reducing the septic state by adequate draining, hydration, correction
of electrolyte imbalances, parenteral antibiotics, somatostatin-14 trial,
bowel rest, parenteral nutrition, cutaneous protection, and surgical correction
using resection with anastomosis or bypass procedures if the ECF fails
to respond to conservative measures.
References:
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JM, Parc R: High-output external fistulae of the small bowel: management
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treatment of upper gastrointestinal fistulas. Gut 49: iv21-iv28, 2002
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in the management of enterocutaneous fistulae. J Coll Physicians Surg Pak.
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6- Ahmad RR, Fawzy SY: Enterocutaneous fistula. Causes
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