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KMID : 0378019900330120029
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New Medical Journal
1990 Volume.33 No. 12 p.29 ~ p.37
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Clinical Review of Enterocutaneous Fistula
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Abstract
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A Clinical review is made on 28 cases presenting with the diagnosis of enterocutanenus fistula at Depart. of Surgery School of medicine, Korea University, during 5 years of the study period from January 1985 to December 1989.
The results are summarized as followings
1) Among total 28 cases, 10 cases were transferred from other institutions after diagnosis of enterocutaneous fistula, Eighteen cases were male(64.3%), while 10 cases(14.3%) were female, The most prevalent age group was 30´s(53.6%).
2) most common anatomic location of the fistula formation were large bowel in 15 cases (35.6%), small bowel in 5 cases(17.8%), gastroduodenum in 4 cases(14.3%), gastrojejunal anastomosis in 2 cases(7.1%), and iliocolic anastomosis in 2.cases(7.1%) in order of frequency, Also multiple fistula formation were seen in 5 cases(17.9%).
3) Twenty three cases of the fistulas developed after surgery as postoperative complication, In contrast, 5 cases(17.9%) were not associated with surgical procedures. 7 cases of postoperatively developed fistulas were from leaking anastomosis, but remainder 9 cases occurred at other sites remote from operative field, The interval between the surgery and diagnosis of fistulas were within postoperative 6th to 10th day in 10 cases (35.7%).
4) In 12 cases(42.9%) the amount of fistula output was below 100ml per day, in 6 cases between 100 to 500m1 per day, and in 10 cases (37.5%) over 500m1 per day, More than half(53. 6%) of patients showed the fistula output over 200m1 per day.
5) Early diagnosis was possible with oral methylene blue installation in some cases. In later stage of the disease after maturation of the fistula tract, fistulogram with water-soluble contrast dye was used most commonly, Upper G - I series and barium enema were also used to confirm the diagnosis.
6) Surgical treatment carried out in 16 cases (57.9%). Indications for surgery were persistently draining fistula in 12 cases(75%), intra-abdominal abscess in 3 cases(8.75%), and intra-abdominal bleeding in one case(6.52%), Among these 16 cases, 13(81.25%) were cured, one case(6.25%) recurred, and 2 cases(12.5%) died of their disease.
7) Among 13 cases with low-output fistula, of those draining less than 200m1 per day, 8 cases underwent conservative treatment which was successfully in 6 cases, and remainder 5 cases underwent surgery also with successful outcome, Among 15 cases with high-output fistula draining over 200m1 per days, 3 cases were cured and one case died.
8) As complication of the enterocutaneous fistula, 14 cases(50%) of wound infection, 12 cases (42.9%) of intra-abdominal abscess, 10 cases (35.7%). of skin digestion around fistula opening, 5 cases (17.9%) of electrolytes imbalance, and 3 cases (10.7%) of malnutrition were
noted.
9) Among total 28 cases, 5 cases died with mortality of 17.9% : 3 cases of sepsis and 2 cases of malnutrition.
Based on these results, it is fair to say that prevention of this dreadful complication is important by strictly observing to the surgical principle and rejection of any anastomosis in septic environment, and once at formed, early aggressive medical support and. also proper surgical decision when indicated is needed swiftly.
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KEYWORD
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