Review of a hospital experience of enterocutaneous fistula

A retrospective analysis of records of 46 patients with enterocutaneous fistulas treated over a period of three and half years has been done. There were 28 males and 18 females, with 80% of patients being in age group of 25-35 years. Forty-five patients were postoperative and in one patient fistula occurred spontaneously. Tuberculosis was the most common underlying pathology, seen in 32.6% followed by enteric fever in 23.9%. The small intestine was the most common site for the origin of fistula, seen in 34 patients (73.9%). There were 22 patients with high output fistula and 24 with low output. For high output fistulas, enteric fever was the most common cause (45%) and ileum was the most site of origin (82%). Low output fistulas were mainly of tubercular aetiology (62%) and involved ileum in 62% of cases. Nineteen out of 22 patients of high output fistulae had sepsis. Fourteen of these had generalised peritonitis (63%) and 5 had localized intra-abdominal collections (27%). Spontaneous closure occurred in 45.6% of patients on conservative management and 37% patients underwent surgical intervention. The overall mortality was 30.4%. High output fistulae had mortality figure of 54.5% and low output fistulas 8.4%. Mortality in relation to sepsis was 63%. No patient with sepsis and without surgical intervention survived. Following surgical intervention mortality was 50% in patients who showed evidence of sepsis. Early and effective control of sepsis is the most important factor determining outcome in patients of enterocutaneous fistula.