A Clinical Study on Comprehensive Analysis of Enterocutaneous Fistula

Abstract

BACKGROUND An enterocutaneous fistula (ECF) is an abnormal communication between the small or large bowel and the skin. It is one of the serious complications of gastrointestinal surgery and has a mortality rate of up to 20%. Management involves dealing with malnutrition, sepsis, metabolic derangement and electrolyte imbalance. METHODS This is a combined prospective and retrospective study conducted at SVMC & RC from June 2017 to May 2019. Thirty patients with ECF were enrolled in this study. Patients with biliary, pancreatic and anal fistulas were excluded. Factors influencing spontaneous closure of fistula such as fistula characteristics, organ of origin, sepsis etc. were studied. Initial management for all patients was conservative with restoration of fluid and electrolyte imbalance, and were initially started on parenteral nutrition using dextrose 10%, Astymin, Intralipid, human albumin and total parenteral nutrition (TPN). RESULTS Fistula closed spontaneously in 22 patients. Operative closure was done in 5. Death occurred in 3 (mortality rate-10%). Out of 30 fistulas, 28 were post-operative fistulas. One was due to trauma and one was due to Crohn's disease. Among the former, 83% developed a fistula following emergency surgery. Albumin levels after 3 weeks of treatment, were predictive of both spontaneous closure and mortality. CONCLUSIONS Post-operative causes account for majority of enterocutaneous fistulas. Anatomical origin of fistula, associated factors like sepsis, malnutrition, hypoalbuminemia and abdominal wall defect, influence the spontaneous closure. Total parenteral nutrition increases the spontaneous closure rate of fistulas and decrease mortality rate.