Rationale in management of entero-cutaneous fistula following                  routine and emergency surgery: a prospective study in a tertiary care hospital of Odisha

Jagmohan Mishra; Afroza Firodous; Biplab Mishra

doi:10.18203/2349-2902.isj20185034

Authors

Jagmohan Mishra Department of General and Laparoscopic Surgery, S.C.B Medical College, Cuttack, Odisha, India
Afroza Firodous Department of General and Laparoscopic Surgery, S.C.B Medical College, Cuttack, Odisha, India
Biplab Mishra Department of General and Laparoscopic Surgery, S.C.B Medical College, Cuttack, Odisha, India

DOI:

https://doi.org/10.18203/2349-2902.isj20185034

Keywords:

Enterocutaneous fistula, Emergency laparotomy, Routine G. I. surgery

Abstract

Background: The enterocutaneous fistula is an abnormal communication between gastrointestinal tract and skin. It is a grave surgical complication following surgery on gastrointestinal tract. Despite in surgical nutrition and critical care, mortality from enterocutaneous fistula remains high. Improvements in outcome are focused on prevention and when fistula occurs, prompt recognition and intervention is essential.

Methods: This is institutional based prospective observational study which was conducted in S.C.B Medical college, Cuttack, Odisha for a period from September 2015 to September 2017 on 30 patients with enterocutaneous fistulae occurring as post-operative complication among patients admitted and operated at our institution for various gastrointestinal conditions and also referred from other centres after complication had set in. Detailed history, physical examination, routine workup, management and its outcome were studied.

Results: The maximum number of fistulae (86.7%) developed after emergency surgery than routine. Incidence of enterocutaneous fistulae was observed in cases operated for intestinal obstruction (40%) followed by operation for enteric perforation (28%). The highest incidence of enterocutaneous fistula occurred on 8^th post-operative day (36.7%). 24 cases were treated conservatively while 6 patients underwent operative treatment.

Conclusions: Hence, the enterocutaneous fistula is frequently seen with emergency surgery of gastrointestinal tract, particularly on ileum, usually occurring around 8^th post-operative day and most of them end in spontaneous closure with conservative treatment.

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References

Carlson G, Epstein J, Mc Mortensen NJ, Ashraf S. The small intestine. In: Williams N, O’Connell R, Mc Caskie A W, eds. Bailey& Love‘s Short Practice of Surgery, 27th ed. Boca Raton, Florida BR: CRC Press;2018:1256.

Tawadros PS, Simpson J, Fischer JE, Rotstein OD. Abdominal Abscess and Enteric Fistulae. In: Maingot R, Zinner MJ and Ashley SW, eds. Maingot’s Abdominal Operations, 12th ed. New York, NY: McGraw-Hill;2013:204-214.

Fischer JE, Evenson AR, Gastrointestinal-Cutaneous Fistulas. In: Fischer JE. ed. Fischer’s Master of Surgery, 6th ed. New Delhi, ND: Wolters Kluwer India Pvt Ltd;2012:1564-1574.

Harris JW, Evers BM. Small intestine. In: Townsend, Jr CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery, The Biological Basis of Modern Surgical Practice,1st SOUTH ASIA ed. New Delhi, ND: Elsevier;2016:1286-1289.

Irving M. Local and surgical management of enterocutaneous fistulas. Br J Surg. 1977;64:690-4.

Edmunds LH Jr, Williams GM, Welch CE. External fistulas arising from the gastro-intestinal tract. Ann Surg. 1960;152:445-71.

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

Halversen RC, Hogle HH, Richards RC. Gastric and small bowel fistulas. Am J Surg. 1969;118:968.

Roback SA, Nicoloff DM. High output enterocutaneous fistulas of the small bowel: An analysis of 55 cases. Am J Surg. 1972;123:317.

Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE. Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? An affirmative answer. Ann Surg. 1969;169(6):974-84.

Fischer JE, Foster GS, Abel RM, Abbott WM, Ryan JA. Hyperalimentation as primary therapy for inflammatory bowel disease. Am J Surg. 1973;125:165.

MacFadyen BV Jr, Dudrick SJ, Ruberg RL. Management of gastrointestinal fistulas with parenteral hyperalimentation. Surgery. 1973;74(1):100-5.

Nassos TP, Braasch JW. External small bowel fistulas: Current treatment and results. Surg Clin North Am. 1971;51:687.

Sheldon GF, Gardiner BN, Way LW, Dunphy JE. Management of gastrointestinal fistulas. Surg Gynecol Obstet. 1971;133:385.

Marshall SF, Gerber ML. Persistent fecal fistula. Surg Clin North Am. 1950;30(3):901-9.

Blackett RL, Hill GL. Postoperative external small bowel fistulas: A study of a consecutive series of patients treated with intravenous hyperalimentation. Br J Surg. 1978;65:775.

Soeters PB, Ebeid AM, Fischer JE. Review of 404 patients with gastrointestinal fistulas. Impact of parenteral nutrition. Ann Surg. 1979;190(2):189-202.

Aguirre A, Fischer JE, Welch CE. The role of surgery and hyperalimentation in therapy of gastrointestinal-cutaneous fistulae. Ann Surg. 1974;180(4):393-401.

Bury KD, Stephens RV, Randall HT. Use of a chemically defined, liquid, elemental diet for nutritional management of fistulas of the alimentary tract. Am J Surg. 1971;121(2):174-83

Voitk AJ, Echane V, Brown RA, McArdle AH, Gurd FN. Elemental diet in the treatment of fistulas of the alimentary tract. Surg. Gynecol. Obstet.1973;131:68.

Rocchio MA, Cha CJ, Haas KF, Randall HT. Use of chemically defined diets in the management of patients with high output gastrointestinal cutaneous fistulas. Am J Surg. 1974;127:148-56.

Kaminsky VM, Deitel M. Nutritional support in the management of external fistulas of the alimentary tract. Br J Surg. 1975;62:100-3.

Athanassiades S, Notis P, Tountas C. Fistulas of the gastrointestinal tract. Experience with eighty-one cases. Am J Surg. 1975;130:26-28.

Sitges‐Serra A, Jaurrieta E, Sitges‐Creus A, Management of postoperative enterocutaneous fistulas: The roles of parenteral nutrition and surgery. Br J Surg. 1982;69:147-50.