Nutrition and management of enterocutaneous fistula

Abstract

Management of enterocutaneous fistula should initially concentrate on correction of fluid and electrolyte imbalances, drainage of collections, treatment of sepsis and control of fistula output. The routine use of somatostatin infusion and somatostatin analogues remains controversial; although there are data suggesting reduced time to fistula closure, there is little evidence of increased probability of spontaneous closure. Malnutrition is common and adequate nutritional provision is essential, enteral where possible, although supplemental parenteral nutrition is often required for high-output small bowel fistulas. The role of immunonutrition is unknown. Surgical repair should be attempted when spontaneous fistula closure does not occur, but it should be delayed for at least 3 months.

Treatment Options in Gastrointestinal Cutaneous Fistulas

“…25,30 The role of these two drugs is more pronounced in patients in whom oral intake is attempted. They should be given half an hour before meals.…”

“…Decreasing fistula output could aid in promoting fistula closure; however, this is controversial. 30 Though some studies documented significant reduction in fistula output, most studies to date have not shown higher fistula closure rate or shortened fistula closure time. [31][32][33][34][35][36][37][38][39][40] Data in these and other studies are confounded by the small numbers of patients included, inclusion of a large proportion of patients with pancreatic fistulas together with patients with enterocutaneous fistula, and heterogeneity within the patient cohorts studied.…”

Surgical treatment of patients with enteric fistulae

“…Кан-шиным) или У-образный дренаж Чаффина [1]. Для защиты кожи от агрессивного воздействия кишеч-ного содержимого в комбинации с дренированием использовали антимикробные разрезаемые пленки [7,10,12].…”

A Case of Enterocutaneous Fistula Diagnosed with Tc-99m DTPA Fistulography Using Hybrid SPECT/CT

“…Approximately onethird of patients might be cured spontaneously with supportive management. If nonoperative management and spontaneous fistula closure fails, the treatment of choice is surgery [3,4]. Thus, correct diagnosis and anatomical information of ECF are crucial for a patient's management.…”