Management of Enterocutaneous Fistulas

Juan J. Sancho, Raquel Hernandez, Meritxell Girvent, Antonio Sitges-Serra

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    Abstract

    A time-oriented approach is the key to management of enterocutaneous fistulas. During the 2 initial days the diagnosis and classification should be completed. Then, stabilization of the patient including maintenance of the hydroelectrolytic balance, assessment of the nutritional status and treatment of sepsis must be accomplished. The third week is usually devoted to giving appropriate nutritional support, fully characterizing the fistula anatomy and, if indicated, starting pharmacological treatment. If medical treatment fails, planned reintervention is on order. Nutritional support is of paramount importance for the spontaneous closure of enterocutaneous fistulas. Treatment with octreotide is only effective in accelerating fistula closure and only when it has already stabilized, usually after the first 2 weeks. Fistulas arising from large bowel defects or draining through wound dehiscence are poor candidates for spontaneous closure. With correct treatment, 70-80% spontaneous closure may be expected, with a mortality rate of 5-12%. © 1997 S. Karger AG, Basel.
    Original languageEnglish
    Pages (from-to)483-491
    JournalDigestive Surgery
    Volume14
    Issue number6
    DOIs
    Publication statusPublished - 1 Jan 1997

    Keywords

    • Cutaneous fistula
    • Enterocutaneous fistula
    • Octreotide
    • Parenteral nutrition
    • Postoperative care

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