Enterocutaneous fistula

Background

Abnormal connection from the gastrointestinal tract to the skin
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

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