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

Abstract

Background: An Enterocutaneous fistula (ECF) is an abnormal connection between the intestinal tracts or stomach and the skin. They are a major catastrophe to the patient and surgeons and still have a high incidence of morbidity and mortality which varies between 6% -33%; their management remains a big challenge. These patients frequently face complications, and a well-organized multidisciplinary approach must be implemented in their management to improve outcomes. Objectives: Our study aims to assess the prevalence, management and outcomes of enterocutaneous fistulas in Buea regional hospital and Laquintinie hospital of Douala over the past 5 years. Methods: This was a hospital-based retrospective study in Buea regional hospital and Laquintinie hospital of Douala. Records of patients who had enterocutaneous fistulas within the period of 1 st January 2017 to 31 st December 2020 in the surgical departments. Data included demographics, pre-operative diagnosis, comorbidities, type of fistula, management modality and means, the indication of operative treatment, length of stay in the hospital and outcomes. Data was analysed using SPSSv26. Results: The study constituted 1343 medical records of which 83 medical records of patients with enterocutaneous fistulas, giving a prevalence of 6.2%, female predominance at 59% (n = 49), 42.2%

Factors Associated with Management Outcomes of Enterocutaneous Fistula Patients at the University of Dodoma Affiliated Teaching Hospitals

“…In our research, we observed that age above 40 years, the presence of small bowel enterocutaneous fistulas (ECF), and lower hemoglobin levels were all identified as statistically significant predictors of unfavorable outcomes. These findings align with previous studies conducted in various regions, including Tanzania [18], India, Nigeria, Iraq, Cameroon, and Guinea [12,20,21,24,[31][32][33][34][35][36][37][38], where similar predictors with addition of comorbidities like HIV and diabetes mellitus were also reported as contributing factors to poor ECF outcomes. It's crucial to remember that small bowel fistulas typically have a high output, which can cause electrolyte imbalances and hypoalbuminemia because of the natural fluid leakage of fistulas and the frequently noticed impaired nutritional status in ECF patients [39].…”

“…This phenomenon is not unique to Tanzania, as mortality rates of a similar magnitude have been observed in various other regions. For instance, studies conducted in Cameroon revealed a mortality rate of 38.6% [21], aligning with findings from Muhindo's study in Congo and studies in Nigeria, each reporting mortality rates exceeding 30% and studies conducted in India documented a mortality rate of 29% [19,[21][22][23][24]. These cumulative observations underscore the persistent challenges in managing ECF and the need for concerted efforts to improve patient outcomes across different geographical contexts.…”