Acta Scientific Clinical Case Reports

Review Article Volume 1 Issue 11

A New Challenge: Enterocutaneous Fistula Diagnosis and Management

Nanda Rachmad Putra Gofur1*, Aisyah Rachmadani Putri Gofur2, Soesilaningtyas3, Rizki Nur Rachman Putra Gofur4, Mega Kahdina4 and Hernalia Martidal Putri4

1Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia
2Faculty of Dental Medicine, Universitas Airlangga, Surabaya, Indonesia
3Department of Dental Nursing, Poltekkes Kemenkes, Surabaya, Indonesia
4Faculty Of Medicine, Universitas Airlangga, Surabaya, Indonesia

*Corresponding Author: Nanda Rachmad Putra Gofur, Department of Health, Faculty of Vocational Studies, Universitas Airlangga, Surabaya, Indonesia.

Received: November 13, 2020; Published: November 27, 2020



Introduction: Enterocutaneous fistulas mostly (75% - 90%) occur iatrogenically postoperatively. In one study, as many as 95% of enterocutaneous fistulas occurred postoperatively, and the ileum was the most common site for enterocutaneous fistulas. Other enterocutaneous fistulas in 10% - 25% occur spontaneously or as a result of intrinsic abnormalities such as Crohn's disease, radiation enteritis, distal obstruction, or abscess or peritonitis. The risk factors for postoperative enterocutaneous fistula include technical and patient risk factors. Technical risk factors include poor preparation for surgery, operating techniques, and postoperative handling. While the patient's risk factors include age, underlying medical conditions and risky lifestyle. Management of enterocutaneous fistulas requires the involvement of a surgeon, nutritionist, enterostomal therapist, interventional radiologist and gastroenterologist. The fistula must be staged appropriately by combining the patient's clinical condition with investigations such as fluoroscopic contrast studies, fistulography, and CT scan.

Objective: Diagnosis and management in the form of reoperative intervention may be required in some patients based on several factors which will be discussed further.

Discussion: Generally, complaints of postoperative fever and abdominal pain. It is necessary to ask about what operations have been performed and for what indications, underlying diseases such as inflammatory bowel disease, malignancy, distal bowel obstruction, history of radiation, and other conditions the patient has. The definitive diagnosis of enterocutaneous fistula is usually made by visualization of the drain from the surgical incision or from the drain site. Taking all these risk factors into account, it is evident that patients undergoing emergency surgery have a higher rate of fistula formation whereas it is not possible to change many of these factors in the situation as they arise. Operations performed for adhesions, bowel obstruction, cancer, radiation enteritis, or inflammatory bowel disease have the highest rates of fistula formation. It is in these cases that the meticulous surgical technique previously described and the appropriate postoperative care are the mainstays of fistula prevention.

Conclusion: Management of enterocutaneous fistulas is still a challenge to date, although the development of supportive patient management has recently progressed. Once identified, a three-phase approach which includes stabilization consisting of resuscitation and treatment of sepsis, staging and supportive management of optimization of medical and nutritional conditions and, in some cases, definitive surgical intervention is required, which requires careful planning, proper dissection, resection and reanastomosis and reconstruction of the intestine and abdominal wall are of great concern. Most fistulas resolve spontaneously within 4 to 6 weeks with conservative management.

Keywords: Enterocutaneous Fistula; Diagnosis; Management; Risk Factor



  1. Townsend Beauchamp Evers and Mattox. Sabiston Textbook Surgery The Biological Basis of Modern Surgical Practical 19th ed. Philadelphia: Saunders Elsevier (2012).
  2. Galie KL and Whitlow CB. “Postoperative enterocutaneous fistula: When to reoperate and how to succeed”. Clinic in Colon and Rectal Surgery4 (2006): 237-246
  3. Kumar P., et al. “Enterocutaneous fistulae: Etiology, treatment, and outcome - A study from South India”. Saudi Journal of Gastroenterology6 (2011): 391-395.
  4. Berry SM and Fischer JE. “Classification and pathophysiology of enterocutaneous fistulas”. Surgical Clinics 76 (1996): 1009-1018.
  5. Campos AC., et al. “A multivariate model to determine prognostic factors in gastrointestinal fistulas”. Journal of the American College of Surgeons 188 (1999): 483-490.
  6. Sinha SK., et al. “Multiple spontaneous enterocutaneous fistulae in malakoplakia”. Indian Journal of Gastroenterology 22 (2003): 234-235.
  7. Chambers WM and Mortensen NJ. “Postoperative leakage and abscess formation after colorectal surgery”. Best Practice and Research: Clinical Gastroenterology 18 (2004): 865-880.
  8. Makhdoom ZA., et al. “Nutrition and enterocutaneous fistulas”. Journal of Clinical Gastroenterology 31 (2000): 195-204.
  9. D’Harcour JB., et al. “Percutaneous management of enterocutaneous fistulas”. American Journal of Roentgenology 167 (1996): 33-38.
  10. Eleftheriadis E., et al. “Therapeutic fistuloscopy: an alternative approach in the management of postoperative fistulas”. Digestive Surgery 19 (2002): 230-236.
  11. Fazio VS., et al. “Factors influencing the outcome of treatment of small bowel cutaneous fistula”. World Journal of Surgery 7 (1983): 481-488.
  12. Frank KH Netter. Atlas of human anatomy 4th edition. Mosby/Elsevier Inc (2006).
  13. Guyton AC and Hall JE. Textbook of medical physiology 11th edition. Philadelphia: Elsevier Inc.
  14. Ortiz LA., et al. “Treatment of enterocutaneous fistulas, then and now”. Nutrition in Clinical Practice10 (2017): 1-8.
  15. Schecter WP., et al. “Enteric fistulas: principles of management”. Journal of the American College of Surgeons 4 (2009): 484-491.
  16. Lewis SJ., et al. “Early enteral feeding versus“nil by mouth” after gastrointestinal surgery: systematic review and metaanalysis of controlled trials”. BMJ7316 (2001): 773-776
  17. McClave SA and Heyland DK. “The physiologic response and associated clinical benefits from provision of early enteral nutrition”. Nutrition in Clinical Practice 3 (2009): 305-315.
  18. Lee SH. “Surgical management of enterocutaneous fistula”. Korean Journal of Radiology51 (2012): S17-S20.
  19. Lynch AC., et al. “Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery”. Annals of Surgery 240 (2004): 825-831.
  20. Lloyd DAJ., et al. “Nutrition and management of enterocutaneous fistula”. British Journal of Surgery 93 (2006): 1045-1055.
  21. Campos AC., et al. “A multivariate model to determine prognostic factors in gastrointestinal fistulas”. Journal of the American College of Surgeons 188 (1999): 483-490.
  22. Beglinger C and Drewe J. “Somatostatin and octreotide: physiological background and pharmacological application”. Digestion 60 (1999): 2-8.
  23. Kutz K., et al. “Pharmacokinetics of SMS 201-995 in healthy subjects”. Scandinavian Journal of Gastroenterology 119 (1986): 65-72.
  24. Leandros E., et al. “Somatostatin versus octreotide in the treatment of patients with gastrointestinal and pancreatic fistulas”. Canadian Journal of Gastroenterology 18 (2004): 303-306.


Citation: Nanda Rachmad Putra Gofur., et al. “A New Challenge: Enterocutaneous Fistula Diagnosis and Management". Acta Scientific Clinical Case Reports 1.11 (2020): 19-25.


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