A clinical studies were performed on 44 cases presenting with the diagnosis of postoperative enterocutaneous fistula to evaluate and paln, the optinal treatment strategies at Department of Surgery, college of Medicine, Korea University between
January
1985 and December 1993.
@ES The following results were obtained.
@EN 1) Among total 44 cases, 17 cases were transferred from other institutions after the diagnosis of enterocutaneous fistula made. The most prevalent age was 30's and 40's, 29 cases were male (65.9%) and 15 cases were female(34.1%).
2) The most common anatomic location of the fistula was from large bowel, 22 cases(52.2%) and among the those ceum was the most common site.
3) Twenty none cases were developed after surgery as postoperative complication and 15 cases were not associated with only surgical procedures. Among the 29 cases, 12 cases were from surgical injury, 12 cases from anastomotic leakage, and the 5
cases
from stump leakage (2 cases) and imple closure leakage (3 cases).
4) In 21 cases(47.7%), the amount of fistula output was below 200ml per day, in 12 cases(27.3%) between 200 to 500 ml per day and in 11 cases(25%) over 500 ml per day.
5) The diagnostic accuracy of fistulogram was higher than other diagnostic methods.
6) Surgical treatment was carried out in 25 cases(56.8%). Indication for surgery were persistently draining fistula, intraabdominal abscess, peritomtic intraabdominal bleeding and distal obstruction. In cases of small bowel fistula, surgical
approach
had been employes more frequently, while conservative treatment was exercised in large bowels, 19 cases(43.2%).
7) As complication of the enterocutaneous fistula, skin marcerations were noted commonly in cases of upper intestinal tistulas and pulmonary complications noted in cases of anastomotic leakage. Six cases died with mortality of 13.6%.
In conclusion, early aggressive medical support is uppermost improtant and proper surgical decision according to individual characteristics of the fistula is indicated.
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