Management of intestinal fistulas

Chapman, Richard; Foran, Robert F.; Dunphy, J. Englebert

doi:10.1016/0002-9610(64)90005-4

Cited by 165 publications

(81 citation statements)

References 7 publications

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“…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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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%

Enterocutaneous Fistulas: A Look at Causes and Management

2014

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“…The more acute the development of sepsis and associated mul tiple organ failure in the postoperative period, the more urgent the need for clinical decision making [25]. As stated by Chapman et al [12] more than 30 years ago, 'under no circumstances should a patient be allowed to go downhill progressively without an operative search for occult sepsis'. When an early operation must be carried out.…”

Section: Surgical Repairmentioning

confidence: 99%

“…Two categories of measures may be considered: those oriented to remove the effluent, and those oriented to cover the skin. Among the former, gravity drainage using a split mattress was advocated in the past by some authors [ 12], while the use of suction drains is now widely used to col lect the fistulous output away from the skin [3,7,15,16]. The techniques for covering the skin involve the use of some adherent and inert paste compound in association with impermeable dressings.…”

Section: Cutaneous Carementioning

confidence: 99%

“…Hvpoalbuminemia results from decreased intake and excessive losses of protein and from expansion of the extracellular volume and muscle proteo lysis secondary to sepsis [11]. Before the advent of paren teral nutrition, malnutrition was a major determinant of adverse outcome in patients with EFs [1,9,12]. Parenter al nutrition dramatically decreases fistula output [1] and supports host defenses and normal healing.…”

Section: Nutritionmentioning

confidence: 99%

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Management of Enterocutaneous Fistulas

Sancho¹,

Hernández²,

Girvent³

et al. 1997

Dig Surg

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A time-oriented approach is the key to management of enterocutaneous fistulas. During the 2 initial days the diagnosis and classification should be completed. Then, stabilization of the patient including maintenance of the hydroelectrolytic balance, assessment of the nutritional status and treatment of sepsis must be accomplished. The third week is usually devoted to giving appropriate nutritional support, fully characterizing the fistula anatomy and, if indicated, starting pharmacological treatment. If medical treatment fails, planned reintervention is on order. Nutritional support is of paramount importance for the spontaneous closure of enterocutaneous fistulas. Treatment with octreotide is only effective in accelerating fistula closure and only when it has already stabilized, usually after the first 2 weeks. Fistulas arising from large bowel defects or draining through wound dehiscence are poor candidates for spontaneous closure. With correct treatment, 70-80% spontaneous closure may be expected, with a mortality rate of 5-12%.

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“…T h e importance of calorie intake with regard to the final outcome has been reported (Chapman, Foran, and Dunphy, 1964). These authors report 7 cases of gastric and gastrojejunal fistula, with 2 deaths.…”

mentioning

confidence: 89%