Abstract

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

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Citation

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.

Copyright

Copyright: © 2020 Nanda Rachmad Putra Gofur., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.