Experience with enterocutaneous fistula management in a district hospital in Nigeria

Abstract

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.

Prevalence, Management and Outcomes of Enterocutaneous Fistulas in Buea Regional Hospital and Laquintinie Hospital of Douala. A Five Years Retrospective Study

“…[4] [13] but higher than the study done by Quinn M in the UK where she had 30.7% of cases who were referred [4]; these findings could be explained on the one hand by the difficulty of taking charge of fistulas by peripheral structures in our country and on the other hand by the delay put for the treatment of the initial pathology, but the differences in percentages can be explained by the different sample sizes. 96.4% occurred as post-operative complications following laparotomies, 2.4% occurred spontaneously in patients who had GI cancer and 96.5% of ECF as a postoperative complication [14] but slightly higher than other studies [4]; so our result is in line with what is writing in literature, which staple that the most common cause of ECF is iatrogenic and occurs in the postoperative period. As postoperative complication, 41% occurred secondary to emergency surgeries while 16.8% were secondary to elective surgeries.…”