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Aetiology, Pathology and Management of Enterocutaneous Fistula
Aetiology, Pathology and Management of Enterocutaneous Fistula
PATHOPHYSIOLOGY
MANAGEMENT PROTOCOL
PREVENTION
CONCLUSION
Enterocutaneous fistula is an abnormal
communication between a intestine & the
skin. It is also called external intestinal fistula
Highoutput- >500ml/24hrs
Moderate Output- 200-500ml/24hrs
IV. Fistula at any site with assoc large abd. Wall defect
60%
SURGERY-(commonest cause) .usually due to
unrecognised injury to bowel as a result of careless
dissection or due to breakdown of anastomosis
Sepsis
Intra-abdominal sepsis
Wound infection
Skin problems.
Anaemia
Portion of gut below the fistula is by-passed
resulting in malabsorption of essential nutrients
Large fistula
High fistula
Distal obstruction
Advances in electrolyte replacement & nutritional
support measures have allowed surgeons to
maintain pts in a good condition until the fistula
closes spontaneously or the pt becomes fit for a
definitive surgical correction
PHASE
Enteral nutrition-orally
-NG tube
-Gastrostomy, Jejunostomy
Nitrogen requirement= Daily urinary nitrogen
excretion + 3-4g
Septic pts=25-30g(10-15g)
Energy Req = 4000-5000kcal/day(rarely exceeds
2000-3000kcal/day)
O/E
Fever, tarchycardia, abd. Tenderness, guarding,
rigidity
Signs of Dehydration & Malnutrition
Discharging wound
FISTULOGRAPHY- valuable for narrow well defined
fistula opening, doubtful value for high output
fistula in depths of gaping wounds
-outline track & abscess cavity
Distal obstruction
Radiation enteritis
-selective embolization
Venous thromboembolism
-Anticoagulants
PHARMACOLOGIC TREATMENT
H2 Antagonist gastroduodonal fistulae