Enterocutaneous fistula
From IDWiki
Background
- Abnormal connection from the gastrointestinal tract to the skin
Etiologies
- Surgical complications
- Diverticular disease
- Crohn disease
- Malignancy
- Radiation
- Infection, particularly with perianal fistulas
- Includes tuberculosis and actinomycosis
Risk Factors for Persistence
- Mnemonic is HIS FRIEND
- High output
- Inflammatory bowel disease
- Short tract (<2 cm)
- Foreign body
- Radiation
- Infection or inflammation
- Epithelialization
- Neoplasm
- Distal obstruction
Classification
- May be classified by output:
- High output: >500 mL/24 hours
- Moderate output: 200 to 500 mL/24 hours
- Low output: <200 mL/24 hours
- May be classified by etiology:
- Iatrogenic: operations for malignancy, adhesiolysis, IBD, and trauma, mostly from anastomotic leaks
- Spontaneous: IBD, malignancy, appendicitis, diverticulitis, radiation, tuberculosis, actinomycosis, ischemia
- Maybe classified by GI source:
- Type I: abdominal, esophageal, and gastroduodenal
- Type II: small bowel
- Type III: large bowel
- Type IV: enteroatmospheric, regardless of origin
Management
- Needs multidisciplinary care to optimize nutrition, assess fistulous tract anatomy, provide good wound care, and manage the underlying disease
- Nutrition and fluid maintenance is important, especially for high-output fistulas
- When they develop infections:
- Percutaneous drainage of any abscesses
- Antibiotics should cover GI pathogens
- In general, antibiotics are not needed beyond source control
- Duration of about 4 to 7 days is typically enough
Further Reading
- Enterocutaneous Fistula: Proven Strategies and Updates. Clin Colon Rectal Surg. 2016 Jun; 29(2): 130–137. doi: 10.1055/s-0036-1580732
