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KMID : 1033220130030020053
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Journal of Acute Care Surgery
2013 Volume.3 No. 2 p.53 ~ p.56
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Treatment of Enterocutaneous Fistula
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Park Sung-Jin
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Abstract
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Enterocutaneous fistula (ECF) is one of complications that develop after gastrointestinal repair or anastomosis. Depending on its progression, it can lead to significant morbidity or mortality. Risk factors for anastomotic leak include resection and anastomosis, massive perioperative blood and fluid administration, associated pancreatic injuries, the development of the abdominal compartment syndrome, ongoing hypoperfusion and the use of vasopressors during the initial resuscitation and in the early postinjury intensive care unit management. Computed tomography is the best diagnostic imaging study to identify anastomotic leaks. According to drainage volume, fistulas are classified as high output, moderate output, or low output. An ECF is a complication following trauma laparotomy and may be the result of an anastomotic leak, missed injury, or complications with an open abdomen after a damage control surgery. An ECF developing with an open abdomen is referred to as an entero-atmospheric fistula and is the most common type of ECF encountered by trauma surgeons. There are 3 phases in the management of ECF, and that varies with onset, patient’s condition state and the volume of output. The first phase is the recognition of the fistula and patient stabilization. Initial clinical priorities include replacement of fluid and electrolyte, control of sepsis, nutrition, and wound care. The second phase is the period that spontaneous closure of ECF develops or the period before definitive surgery. The third phase is that definitive surgery is performed in a patient with a persistent ECF. After complete lysis of adhesions to prevent distal obstruction, operative methods include resection and anastomosis or oversewing or wedge resection.
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KEYWORD
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Fistula, Enterocutaneous fistula
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