Enterocutaneous fistula: Difference between revisions
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* Abnormal connection from the gastrointestinal tract to the skin |
* Abnormal connection from the gastrointestinal tract to the skin |
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| + | ==== Risk Factors for Perisitence ==== |
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| + | |||
| + | * Mnemonic is HIS FRIEND |
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| + | * High output |
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| + | * IBD |
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| + | * Short tract (<2 cm) |
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| + | * Foreign body |
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| + | * Radiation |
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| + | * Infection or inflammation |
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| + | * Epithelialization |
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| + | * Neoplasm |
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| + | * Distal obstruction |
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| + | |||
| + | ==== Classification ==== |
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* May be classified by output: |
* May be classified by output: |
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** High output: >500 mL/24 hours |
** High output: >500 mL/24 hours |
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Revision as of 15:27, 11 July 2024
Background
- Abnormal connection from the gastrointestinal tract to the skin
Risk Factors for Perisitence
- Mnemonic is HIS FRIEND
- High output
- IBD
- 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
- 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
