Fistulas of the Gastrointestinal Tract

  • An enterocutaneous fistula (ECF):
    • Is an abnormal communication between the small or large bowel and the skin that allows the contents of the stomach or intestines to leak through an opening in the skin

Classification:

  • Congenital types:
    • Tracheoesophageal
    • Vitellointestinal duct
    • Patent urachus
    • Rectovaginal
  • Acquired:
    • Trauma (postoperative)
    • Radiation
    • Malignancy,
    • Infection

Two categories:

  • Low-output fistula:
    • Less than 500 mL/day
  • High-output fistula:
    • Equal or greater than 500 mL/day

Three categories:

  • Low-output fistula:
    • Less than 200 mL/day
  • Moderate-output fistula:
    • 200ml to 500 mL/day
  • High-output fistula:
    • Greater than 500 mL/day
  • Etiology:

The mnemonic FRIENDS can be used to memorize characteristics which impede the closure of ECF:

  • F Foreign body
  • R Radiation
  • I Infection or Inflammatory bowel disease
  • E Epithelialization
  • N Neoplasm
  • D Distal obstruction
  • S Short tract (less than 2 cm)
  • Patients with enteric content exiting a wound on their abdomen are motivated to undergo operation:
    • The majority will close spontaneously within approximately 6 weeks
    • If it has not closed by 12 weeks:
      • It is unlikely to do so and definitive surgery should be planned:
        • The median time to definitive repair from fistula onset was 6 months (range 1 day to 28 months):
          • The 6-month time course is commonly utilized by groups with significant experience treating fistulas, owing to the trend in encountering a less hostile abdomen than in the early phases
          • Some evidence also suggests that somatostatin can be an effective treatment with respect to reducing closure time and improving the spontaneous closure rate of enterocutaneous fistulas
  • References:
  1. Lee SH (2012). “Surgical management of enterocutaneous fistula”. Korean Journal of Radiology. 13 Suppl 1: S17–S20. doi:10.3348/kjr.2012.13.S1.S17. PMC 3341456. PMID 22563283.
  2. Galie KL, Whitlow CB (2006). “Postoperative enterocutaneous fistula: when to reoperate and how to succeed”. Clinics in Colon and Rectal Surgery19: 237–246. doi:10.1055/s-2006-956446. PMC 2780112. PMID 20011327.
  3. Ross H (2010). “Operative surgery for enterocutaneous fistula”. Clinics in Colon and Rectal Surgery23: 190–194. doi:10.1055/s-0030-1262987. PMC 2967319. PMID 21886469.
  4. Stevens, P; Foulkes, RE; Hartford-Beynon, JS; Delicata, RJ (October 2011). “Systematic review and meta-analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula”. European Journal of Gastroenterology & Hepatology23 (10): 912–922. doi:10.1097/MEG.0b013e32834a345d. PMID 21814141.
  5. Metcalf C (1999). “Enterocutaneous fistulae”. Journal of Wound Care8 (3): 141–142. doi:10.12968/jowc.1999.8.3.25854.

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