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[Enterocutaneous fistula in the pediatric population. Clinical experience]
Carlos Baeza Herrera1, Luis Angel Sanchez Fernández, Alejandra I Ortiz Zúñiga
1Profesor Titular del Curso de Cirugía UNAM y Jefe del Departamento de Cirugía. Hospital Pediátrico Moctezuma. Mexico, D.F.
Insights
Managing high-output enterocutaneous fistulas remains a surgical challenge. Aggressive therapy and parenteral nutrition improve outcomes for patients with these complex gastrointestinal issues.
Area of Science:
- Gastroenterology
- Surgical Practice
- Clinical Case Series
Context:
- Enterocutaneous fistulas, particularly high-output ones originating from the small intestine, present significant surgical challenges.
- These fistulas often result from technical errors or poor surgical judgment, leading to major complications.
- The study reports on 34 patients with high-output enterocutaneous fistulas, with causes including appendicitis and conditions in infants.
Purpose:
- To describe the management and outcomes of patients with high-output enterocutaneous fistulas.
- To evaluate the effectiveness of a treatment program involving parenteral nutrition, local care, and antibiotics.
- To highlight the potential of aggressive therapeutic approaches in reducing fistula-related mortality and morbidity.
Summary:
- The study analyzed 34 patients with high-output enterocutaneous fistulas, 14 from appendicitis and 16 in infants.
- Treatment involved central venous line parenteral nutrition, local care, and antibiotics; six patients underwent fistula resection.
- Spontaneous closure occurred in 28 patients, while six patients died.
Impact:
- Aggressive therapeutic strategies, coupled with advanced high-caloric parenteral alimentation, show promise in mitigating mortality and morbidity.
- Improved management protocols can lead to better patient outcomes and reduced complications associated with enterocutaneous fistulas.
- This research contributes to understanding the complexities of enterocutaneous fistula management and informs future treatment strategies.
Background:
The presence of fistulous communications between the small bowel and the skin continues to be one of the most perplexing and challenging problems facing the surgeon today. Their occurrence is a major catastophe of surgical practice because are frequently a result of technical failure or errors in surgical judgement.
Material, Method And Results:
Thirty four patients with high-output enterocutaneous fistulae arising from the small intestine are reported. Fourteen were due to appendicitis and sixteen were infants. Fistula resection were performed in six patients. Spontaneous fistula closure occurred in twenty-eight. Six died. The treatment program included parenteral nutritition thorugh central venous line, local care and antibiotics.
Conclusions:
In recent years, more aggressive therapy accompanied by the development of high caloric parenteral alimentation shows promise of reducing the mortality and morbidity rates associated with these fistulas.
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