Background: Enterocutaneous fistula (ECF) is an abnormal communication between gastrointestinal tract and skin. It is a difficult condition to treat and morbidity and mortality remain high in many centers. Malnutrition and sepsis are the leading causes of death. There are no clear guidelines for optimal nutritional management. Aggressive measures to maintain positive nitrogen balance is the ultimate goal of nutritional management. Our objective was to review the practice of the nutritional management and outcome of ECF in a resource limited setting in Nigeria. Methods: A retrospective study of all patients with ECF managed between 2006 and 2015. Management included resuscitation, control of sepsis, enteral feeding, skin care and timely surgical intervention. Results: A total of 57 patients were managed. Aetiology of ECF in this study was postoperative in 96.5% of cases. Fistula closure was achieved in 51/57 patients (89.5%). Thirtynine (68.42%) fistulae closed spontaneously on conservative management while 12 (21.05%) fistulae healed following restorative surgery. Mortality rate was 10.5%. Rate of healing was related to serum albumin level and fistula output. Conclusion: Aggressive enteral feeding allows a favorable outcome in enterocutaneous fistula after a convalescence period. High output and hypoalbuminaemia were important prognostic variables.
Background: Typhoid intestinal perforation is the most common surgical complication and a significant cause of morbidity and mortality in typhoid fever. Aim: To determine the treatment outcome of patients with typhoid intestinal perforation. Methods: A single-centre retrospective study involving retrieving case notes of all consecutive patients who had surgeries for peritonitis secondary to typhoid intestinal perforation from October 2016 to September 2017. Data were collected with a designed case report form and analysed. Results: Sixty-nine patients had surgeries for typhoid intestinal perforation, of which forty-five (65.2%) were males. The median (range) age of the participants was 10(4-44) years. The commonest complications were surgical site infections 49 (71%) and wound dehiscence 17 (24.6%). The median (range) post-operative hospital stay among the survivors was 13 (7 – 50) days. Enterocutaneous fistula and wound dehiscence were responsible for prolonged hospital stay (x2= 30.126, p value< 0.001 and x2= 45.777, p value< 0.001 respectively). The overall mortality rate was 19 (27.5%). Under-five children had the highest mortality rate 5/15 (33.3%). Mortality was found to be more common among females though the association was not statistically significant (p value = 0.052). Mortality was significantly associated with extended surgical procedures (p value= 0.027). Conclusion: The reported cases of typhoid intestinal perforations at the study centre were high but the mortality rate was comparable to other similar studies in Nigeria. Mortality from typhoid perforation remains high, and the pathology is best prevented
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