[Enterocutaneous fistulas in patients older than 70 years]

Enterocutaneous fistula remains a major complication after abdominal surgery.

We reviewed the charts of patients over 70 years of age with enterocutaneous fistula who were seen in a general surgery department. Special interest was given to mortality-related factors.

A total of 19 patients were seen. The median age was 76 years. All fistulas were postoperative. All patients were managed based on the phases of Chapman and Sheldon. The most common site of presentation was colon, followed by jejunum and duodenal fistulas. More than half of the patients were malnourished at time of presentation. Spontaneous closure presented in eight patients (47%), seven other patients required surgical treatment for closure of their fistulas. Closure of the fistulas was obtained in 15 patients (79%). Four patients died resulting in a mortality rate of 21%. The factors against spontaneous closure were high output (p < 0.03), jejunal fistulas (p < 0.05), hydroelectrolytic imbalance (p < 0.01) and multiple fistulas (p < 0.02). The factors related to mortality were high output (p < 0.04), hydroelectrolytic imbalance (p < 0.02), jejunal fistulas (p < 0.04) and sepsis (p < 0.01).

Patients > 70 years of age with enterocutaneous fistulas have the same mortality reported in the overall population. Sepsis remains the most important cause of death in patients with enterocutaneous fistulas.