Yahya, Z., Ahmed, H., Sultan, H. (2021). Factors that Necessitate Early Surgical Intervention in Patients with Enterocutaneous Fistula. , 21(2), 161-165. doi: 10.52573/ipmj.2021.174624
Zeinab Abdulrahman Yahya; Haider Abdul Hussein Ahmed; Haider Salih Sultan. "Factors that Necessitate Early Surgical Intervention in Patients with Enterocutaneous Fistula". , 21, 2, 2021, 161-165. doi: 10.52573/ipmj.2021.174624
Yahya, Z., Ahmed, H., Sultan, H. (2021). 'Factors that Necessitate Early Surgical Intervention in Patients with Enterocutaneous Fistula', , 21(2), pp. 161-165. doi: 10.52573/ipmj.2021.174624
Yahya, Z., Ahmed, H., Sultan, H. Factors that Necessitate Early Surgical Intervention in Patients with Enterocutaneous Fistula. , 2021; 21(2): 161-165. doi: 10.52573/ipmj.2021.174624

Factors that Necessitate Early Surgical Intervention in Patients with Enterocutaneous Fistula

Iraqi Postgraduate Medical Journal
Article 6, Volume 21, Issue 2, 2022, Pages 161-165    PDF (241.14 K)
Document Type: Research Paper
DOI: 10.52573/ipmj.2021.174624
Authors
Zeinab Abdulrahman Yahya1; Haider Abdul Hussein Ahmed2; Haider Salih Sultan3
1Al-Shaheed Mohammed Baqir Al-Hakeem Hospital, Baghdad, Iraq
2Iraqi Board for Medical Specializations.
3Al Imamain Alkathimain Teaching Hospital, Baghdad, Iraq
Abstract
BACKGROUND:
Most enterocutaneous fistulas are postoperative in origin. Sepsis, malnutrition, and hydroelectrolytic deficit are still the most important complications to which patients with enterocutaneous fistulas are exposed. Knowledge of prognostic factors related to specific outcomes is essential for therapeutic decision making processes.
OBJECTIVE:
A study of enterocutaneous fistula characteristics in terms of etiology, classification (Types), management with special consideration on risk factors necessating early intervention rather than delayed.
PATIENTS AND METHODS:
This study was conducted in the General Surgical department in Al-Imamain Al Kadhimain Medical City at Baghdad, Iraq from March 2018 to August 2020 .Fifty patients with enterocutaneous fistula were included in the study . Assessment of fistula site, output, and associated sepsis was done with focusing on the factors that require surgical intervention.
RESULTS:
50 patient were included in this study, 35 male (70%) and 15 female (30%) mean age was 45±12.4 yrs., Mean BMI was 30.5±4.2.  20 (40%) of the patients had fistula in the jejunum, while 25 (50%) in the ileum and the other 5 (10%) had colonic fistulas. 29 (58%) of patients had high output fistula, while 21 (42%) had low output fistula. Sepsis was present in 21 patients (42%). 12 out of 20 (60%) of patients with jujenal fistula needed surgical intervention, also 15 out of 29 (51.7%) of patients with high output fistula needed surgical intervention, while of the 21 patients who developed sepsis, 14 (66.6%) failed to heal without surgery.
CONCLUSION:
High output fistulas, fistulas associated with sepsis, fistulas of the jujenum required mostly surgical management and had high morbidity.
Keywords
enterocutaneous fistula; Management; sepsis
References
  1. Weledji EP. Perspectives on Enterocutaneous Fistula: A Review Article. Medical & Clinical Reviews. 2017;03.
  2. Hollington P, Mawdsley J, Lim W, Gabe SM, Forbes A, Windsor AJ. An 11-year experience of enterocutaneous fistula. Br J Surg. 2004;91:1646-51.
  3.  West MA. Conservative and operative management of gastrointestinal fistulae in the critically ill patient. Curr Opin Crit Care 2000; 6:143–47.
  4. Lloyd DAJ, Gabe SM, Windsor ACJ Nutrition and management of enterocutaneous fistula. Br J Surg 2006; 93: 1045-55.
  5. Weledji EP, Ngowe NM The challenge of intraabdominal sepsis. Int J Surg 2013; 11: 290-95.
  6. Uba F, Uba S, Ojo E. Management of postoperative enterocutaneous fistulae in children: A decade experience in a single centre. Afr J Paediatr Surg. 2012;9:40.
  7. Taggarshe D, Bakston D, Jacobs M, McKendrick A, Mittal VK. Management of enterocutaneous fistulae: A 10 years’ experience. World J Gastrointest Surg. 2010;2:242-46.
  8. McNaughton V. Summary of best practice recommendations for *management of enterocutaneous fistulae from the Canadian Association for Enterostomal Therapy ECF Best Practice Recommendations Panel. J Wound Ostomy Cont Nurs. 2010;37:173-84.
  9. Garale MN, Takalkar YP, Venkatramani K. Clinical study of enterocutaneous fistula. International Surgery Journal. 2017;4.
  10. 10.  Brenner M, Clayton JL, Tillou A, Hiatt JR, Cryer HG. Risk factors for recurrence after repair of enterocutaneous fistula. Arch Surg 2009;144:500-5.
  11. 11.  Connolly PT, Teubner A, Lees LP, Anderson ID, Scott NA, Carlson GL. Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Am Surg. 2008;247:440-44.
  12. 12.  Dodiyi-Manuel A, Wichendu PN. Current concepts in the management of enterocutaneous fistula. International Surgery Journal. 2018;5.
13. Pearse RM, Morenon RP, Bauer P, Pelosi P, Metnitz P, et al. (2012) Mortality after surgery in Europe: a 7 day cohort study. Lancet.

14. Weledji EP, Chichom AM Aetiology and impact of intraabdominal sepsis on surgical management. East Cent Afr J Surg 2012; 17: 3.

15. Lynch AC, Delaney CP, Senagore AJ, Connor JT, Remzi FH, et al. Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery. Ann Surg 2004; 240: 825-31.

  1. 16.  Evenson AR, Fischer JE (2006) Current management of enterocutaneous fistula. J Gastrointest Surg 10:455–64.
17. Hesse U, Ysebaert D, de Hemptinne B (2001) Role of Somatostatin-14 and its analogues in the management of gastrointestinal fistulae: clinical data. Gut 49: 21.

165
 
18. Lewis SJ, Egger M, Sylvester PA, Thomas S Early enteral feeding versus ‘nil by mouth’ after gastrointestinal surgery : systematic review and meta-analysis of controlled trials BMJ 2001; 323:773-76.

19. Medioros AC, Aires-Neto T, Marchini JS, Brandao-Neto J, Valenca DM, et al. Treatment of postoperative enterocutaneous fistulas by high pressure vacuum with a normal oral diet. Dig Surg 2004; 21: 401-5.

20. Li J, Ren J, Zhu W, Yin L, Han J Management of enterocutaneous fistulas: 30- year clinical experience. Chin Med J (Engl) 2003; 116: 171-75.

21. Schecter WP, Hirshberg A, Chang DS, et al. Enteric fistulas: principles of management. J Am Coll Surg. 2009;209:484-91.

22. Martinez JL, Luque-de-Leon E, Mier J, Blanco-Benavides R, Robledo F. Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes. World J Surg. 2008;32:436-43; discussion 44.

23. Dudrick SJ, Maharaj AR, McKelvey AA Artificial nutrition support in patients with gastrointestinal fistulas. World J Surg 1999;23:570–76.

24. B Memon AS, Siddiqui FG. Causes and management of postoperative enterocutaneous fistulas. J Coll Physicians Surg Pak 2004;14:25-28.

25. Draus JM Jr, Huss SA, Harty NJ, et al. Enterocutaneous fistula: are treatments improving Surgery 2006;140:570–78.

26. Mawdsley JE, Hollington P, Bassett P, Windsor AJ, Forbes A, Gabe SM. An analysis of predictive factors for healing and mortality in patients with enterocutaneous fistulas. Aliment Pharmacol Ther. 2008;28:1111-21.

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