Gastrointestinal fistulae: conservative vs surgical management

Authors

  • Aftab H. Shaikh Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra,
  • Tanay S. Dhanorkar Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra,
  • Ajay H. Bhandarwar Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra,
  • Shivali Chavhan Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra,
  • Gautam Shrotri Department of General Surgery, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra,

DOI:

https://doi.org/10.18203/2349-2902.isj20243230

Keywords:

Comparative study, Gastrointestinal fistula, Management, Surgery, Total parenteral nutrition

Abstract

Background: Gastrointestinal fistulae are abnormal connections between two hollow organs of the gastrointestinal tract or between the hollow organ and the skin. They remain a major clinical problem, especially if complicated by sepsis, bacteraemia or cancer. General Principles of fistula management consist of- Phase of Diagnosis, Stabilization and Management.

Methods: The study was conducted in Sir JJ Group of Hospitals, Mumbai. A total of 34 patients with gastrointestinal fistulae were studied between January 2020 to January 2023. The patients were studied on the basis of presenting signs and symptoms, details of initial surgery performed, investigations pertaining to the condition and their management.

Results: Out of the 34 cases, 44% of the cases were from the small intestine, 39% cases we]re from the large intestine, and the rest of the cases were from stomach, duodenum, gastrojejunostomy site and appendicular stump following appendicectomy.

Conclusions: The database of our retrospective study regarding age and sex incidence, clinicopathological features and therapeutic outcome was comparable to other studies in various literatures.

References

Berry SM, Fischer JE. Biliary and gastrointestinal fistulas. Maingot's abdominal operations. 10th ed. I; 15,593.

Edmunmds LH, Williams GH, Welch CE. External fistulas arising from the gastrointestinal tract. Ann Surg. 1960;152;445-71.

Chapman R, Foron R, Dunphy JE. Management of intestinal fistulas. Am J Surg. 1964;108:157-64.

MacFayden VB, Dudrick SJ, Ruberg RL Management of gastrointestinal fistulas with parenteral hyperalimentation. Surgery. 1973:74:100-5.

Pickhardt PJ, Bhalla S, Balfe DM. Acquired gastrointestinal fistulas: classification, etiologies, and imaging evaluation. Radiology. 2002;224(1):9-23.

Biliary and gastrointestinal fistulas. Maingot's abdominal operations. 10th edition. 1;15:601.

Krzywda EA, Schulte WJ. Surgical nutrition. Manual of Surgical Therapeutics. 9th edition. 1995;11;203-6.

Himal HS, Allard JR, Nadeau JE, Freeman JB, Maclean LD. The importance of adequate nutrition in closure of small intestinal fistulas. Br J Surg. 1974;61(9):724-6.

Kaminsky VM, Dietel M. Nutritional support in the management of external fistulas of the alimentary tract. Br J Surg. 1975;62:100.

Sitges-serra A, Jaurieta E. Sitges-Creusa: Management of post of enterocutaneous fistula. Br J Surg. 1982;69:147-50.

Makhdoom ZA, Komar MJ, Still CD. Nutrition and entercutaneous fistulas. J Clin Gastroenterol. 2000;31(3):195-204.

Santos F, Campos J, Freire J, Andrade A, Tavora I, Castelo HB. Enterocutaneous fistulas an unusual solution. Hepatogastroent. 1997;44(16):1085-9.

O'Brien B, Landis-Eradman J, Erwin-Toth P: Nursing management of multiple enterocutaneous fistulae located in the center of a large open abdominal wound. Ostomy Wound Management. 1998;44(1):20-4.

Hyon SH, Martinex-Garbino JA, Benati ML, LopezAvellaneda ME, Brozzi NA, Argibay PF. Management of a high-output postoperative enterocutaneous fistula with a vacuum sealing method and continuous enteral nutrition. ASAIO J. 2000;46(4):511-4.

Alvarez AA, Maxwell GL, Rodriguex GC. Vacuum assisted closure for cutaneous gastrointestinal fistula management. Gynecol Oncol. 2001;80(3):413-6.

Tassiopoulos AK, Baum G, Halverson JD. Small bowel fistulas. Surg Clin North Am. 1996;76(5):1175-81.

Campos AC, Andrade DF, Campos GM, Matias JE, Coelho JC. A multivariate model to determine prognostic factors in gastrointestinal fistulas. J Am Coll Surg. 1999;188(5):483-90.

Farsi M, Campaioli M, Sarteanesi CG, Picchi G, Sanna A, Menici F, et al. (A new conservative approach in the treatment of postoperative digestive-tract fistulas, mechanical closure by a balloon- catheter). Minerva Chir. 2001:56(1):31-9.

Rolandelli R, Roslyn JJ. Surgical management and treatment of sepsis associated with gastrointestinal fistulas. Surg Clin North Am. 1996;76(5):1111-22.

Kearney R, Payne W, Rosemurgy A. Extra-abdominal closure of enterocutaneous fistula. Ann. Surg. 1997;63(5):406-9.

Fischer JH. The management of high output intestinal fistulas. Adv Surg. 1975;9:139.

Reber HA. Management of external gastrointestinal fistulas. Ann Surg. 1978;188;460-7.

Chang P, Chun JT, Bell JL. Complex enterocutaneous fistula: closure with rectus abdominis muscle flap. South Med J 2000;93(6):599-602.

Downloads

Published

2024-10-28

Issue

Section

Original Research Articles