Enterocutaneous fistula: Are treatments improving?

Draus, John M.; Huss, Sara A.; Harty, Niall J.; Cheadle, William G.; Larson, Gerald M.

doi:10.1016/j.surg.2006.07.003

Cited by 171 publications

(174 citation statements)

References 16 publications

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“…A wellorganized management strategy utilizing of a multidisciplinary team approach is essential. A remarkable amount of time and labor along with intensive resource utilization yields closure rates ranging from 5 to 20 % without surgical intervention and 75-85 % with definitive operative treatment [2,3 • , 4, 5 [7][8][9][10][11]. The team members involved in the care of these complex patients include: general and reconstructive surgeons, nutritional support staff, bedside and enterostomal nursing, social workers, radiologists, internists, psychiatrists and physical therapists, among others [1].…”

Section: Introductionmentioning

confidence: 99%

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Enterocutaneous Fistulas: A Look at Causes and Management

2014

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Despite advances in medical technology and surgical care, the management of enterocutaneous fistulas remains one of the most challenging problems faced by physicians. Success depends on an expert multidisciplinary team, access to long-term enteral and parenteral nutrition support, advanced wound care, optimal medical management and meticulous, methodical, surgical decision-making and technique. Management is complex and multiphasic. Improved survival rates for many morbid problems have resulted in a growing population of patients with increasingly complex fistulas. This article reviews the etiologies as well as classic and evolving management strategies for this problem.

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Section: Introductionmentioning

confidence: 99%

“…Once the fistula has declared itself, the four principles outlined by Chapman et al [14] in 1964 regarding the initial care of patients with ECF still hold true: (1) correction of intravascular volume, (2) drainage of abscess, (3) control of output, and (4) protection of skin.…”

Section: Introductionmentioning

confidence: 99%

Enterocutaneous Fistulas: A Look at Causes and Management

2014

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“…Nevertheless, NPT may help improve wound care before surgery. 24 NPT, similar to other treatment modalities discussed, should not be judged only by its impact on spontaneous closure. It must also be emphasized that application of NPT in patients with enterocutaneous fistula is cumbersome and demands extensive nursing support.…”

Section: Protection Of Surrounding Skin and Soft Tissuementioning

confidence: 99%

Treatment Options in Gastrointestinal Cutaneous Fistulas

Ashkenazi

Turégano-Fuentes

Olsha

et al. 2017

Surg J

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Enterocutaneous fistulas occur most commonly following surgery. A minority of them is caused by a myriad of other etiologies including infection, malignancy, and radiation. While some fistulas may close spontaneously, most patients will eventually need surgery to resolve this pathology. Successful treatment entails adoption of various methods of treatment aimed at control of sepsis, protection of surrounding skin and soft tissue, control of fistula output, and maintenance of nutrition, with eventual spontaneous or surgical closure of the fistula. The aim of this article is to review the various treatment options in their appropriate context.

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“…Usually patients require 1 gN per every 150 kcal, although this ratio may change as the patient's overall condition and response to the nutrition evolves. 6 Patients with underlying IBD are often malnourished and plagued by chronic diarrhea and wasting, and may have increased nutritional requirements over and above the already elevated ones listed. As such, a metabolic cart for ventilated patients or formal nutritional assessment is often helpful to not only guide replacement therapy, but avoid overfeeding as well.…”

Section: Management Of Enterocutaneous Fistulamentioning

confidence: 99%

Enterocutaneous Fistula: Medical and Surgical Management Including Patients with Crohn's Disease

Orangio

2010

Clinics in Colon and Rectal Surgery

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Patients with inflammatory bowel disease (IBD) and especially Crohn's disease can be challenging for even the most seasoned of surgeons. Development of an enterocutaneous fistula (ECF) in these patients further adds a level of complexity that requires a well-planned and defined management strategy. The role of the surgeon in caring for these patients should be as the leader of a multidisciplinary team, directing the care of the other specialists, all while determining if, and when, the patient requires operative intervention. Although medical management has come a long way in these and similar patients, surgery is still needed in a vast majority of patients. Therefore, understanding the evaluation, initial management, and important technical considerations for care of IBD and other complex patients with ECFs is a difficult, yet much needed, task for which the surgeon should be prepared. KEYWORDS: Enterocutaneous fistula, inflammatory bowel disease, Crohn's diseaseObjectives: Upon conclusion of this article, the reader should have a thorough understanding of the medical and surgical principles for managing enterocutaneous fistulas (ECFs) including: (1) the importance of a multidisciplinary approach; (2) early management of ECFs; and (3) the unique challenges patients with underlying inflammatory bowel disease provide.Enterocutaneous fistulas (ECFs) are abnormal connections between the gastrointestinal tract and the skin. The majority ( 85%) of ECFs develop following abdominal surgery for intestinal malignancy, inflammatory bowel disease (IBD), recurrent explorations, or after extensive adhesiolysis for conditions such as small bowel obstruction. The remaining 15% form spontaneously secondary to IBD (Crohn's disease >indeterminate colitis >ulcerative colitis), radiation enteritis, diverticular disease, perforated malignancy, intraabdominal sepsis, and abdominal trauma. Although the origin of the ECF can be essentially anywhere along the gastrointestinal (GI) tract, they most commonly arise from small bowel, colon, stomach, and duodenum in decreasing order. 1,2 As spelled out elsewhere in this issue, the management of the ECF requires a multidisciplinary approach, which will often necessitate aggressive medical and surgical management to try to minimize morbidity and mortality. This is especially true in those patients with underlying inflammatory bowel disease, where the potential for a lifetime of disease recurrence and future function must always be considered. Despite the wide range of underlying causes and patient clinical presentations, some basic tenants must be adhered to

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Enterocutaneous fistula: Are treatments improving?

Cited by 171 publications

References 16 publications

Enterocutaneous Fistulas: A Look at Causes and Management

Enterocutaneous Fistulas: A Look at Causes and Management

Treatment Options in Gastrointestinal Cutaneous Fistulas

Enterocutaneous Fistula: Medical and Surgical Management Including Patients with Crohn's Disease

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