Enterocutaneous fistula
{{Short description|Medical condition}}
An enterocutaneous fistula (ECF) is an abnormal communication between the small or large bowel and the skin that allows the contents of the stomach or intestines to leak through an opening in the skin.{{cite web | url=https://www.nlm.nih.gov/medlineplus/ency/article/001129.htm | title=Gastrointestinal fistula | work=MedlinePlus | access-date=5 November 2014}}
Causes
The mnemonic HIS FRIENDS can be used to memorize characteristics which impede the closure of ECF.{{cite journal | pmc = 3341456 | pmid=22563283 | doi=10.3348/kjr.2012.13.S1.S17 | volume=13 Suppl 1 | title=Surgical management of enterocutaneous fistula | year=2012 | journal=Korean Journal of Radiology | pages=S17–S20 | author = Lee SH}}
H: high output
I: IBD
S:short tract
- F Foreign body
- R Radiation
- I Infection or Inflammatory bowel disease
- E Epithelialization
- N Neoplasm
- D Distal obstruction
- S Short tract (<2 cm)
Diagnosis
=Classification=
Congenital types: tracheoesophageal, vitellointestinal duct, patent urachus, rectovaginal
Acquired: trauma (postoperative), radiation, malignancy, infection
=Two categories=
Low-output fistula: < 500 mL/day
High-output fistula: > 500 mL/day
=Three categories=
Low-output fistula: < 200 mL/day
Moderate-output fistula: 200–500 mL/day
High-output fistula: > 500 mL/day{{cite journal | pmc = 2780112 | pmid=20011327 | doi=10.1055/s-2006-956446 | volume=19 | title=Postoperative enterocutaneous fistula: when to reoperate and how to succeed | year=2006 | journal=Clinics in Colon and Rectal Surgery | pages=237–246 |vauthors=Galie KL, Whitlow CB }}
Treatment
The majority will close spontaneously within approximately 6 weeks. If it has not closed by 12 weeks, it is unlikely to do so and definitive surgery should be planned. The median time to definitive repair from fistula onset was 6 months (range 1 day to 28 months). The 6-month time course is commonly utilized by groups with significant experience treating fistulas, owing to the trend in encountering a less hostile abdomen than in the early phases.{{cite journal | pmc = 2967319 | pmid=21886469 | doi=10.1055/s-0030-1262987 | volume=23 | title=Operative surgery for enterocutaneous fistula | year=2010 | journal=Clinics in Colon and Rectal Surgery | pages=190–194 | author = Ross H}} Some evidence also suggests that somatostatin can be an effective treatment with respect to reducing closure time and improving the spontaneous closure rate of enterocutaneous fistulas.{{cite journal|last1=Stevens|first1=P|last2=Foulkes|first2=RE|last3=Hartford-Beynon|first3=JS|last4=Delicata|first4=RJ|title=Systematic review and meta-analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula.|journal=European Journal of Gastroenterology & Hepatology|date=October 2011|volume=23|issue=10|pages=912–922|pmid=21814141|doi=10.1097/MEG.0b013e32834a345d}}
References
{{Reflist}}
- {{cite journal | author = Metcalf C | year = 1999 | title = Enterocutaneous fistulae | journal = Journal of Wound Care | volume = 8 | issue = 3| pages = 141–142 | doi=10.12968/jowc.1999.8.3.25854}}