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Enterocutaneous fistula. Causes and management
Raafat R Ahmad1, Shawqi Y Fawzy
1Department of Surgery, Gastrointestinal and Hepatology Teaching Hospital, PO Box 61103, Bab-Almuaddam, Medical City, Baghdad, Iraq. rrahmad2003@yahoo.com
Saudi Medical Journal
|September 5, 2007
Summary
Missile injuries are the leading cause of enterocutaneous fistulas. Duodenal and ileal fistulas respond best to conservative treatment, while high-output and jejunal fistulas have poorer outcomes.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Trauma Surgery
Background:
- Enterocutaneous fistula (ECF) is a significant complication following abdominal surgery or trauma.
- Identifying causes and predictors of successful treatment is crucial for patient management.
Purpose of the Study:
- To investigate the primary causes of enterocutaneous fistula.
- To identify factors associated with successful ECF treatment outcomes.
Main Methods:
- A prospective study of 70 consecutive patients with ECF was conducted between November 2002 and October 2005.
- Patients with internal gastrointestinal, pancreatic, or biliary fistulas were excluded.
- Total parenteral nutrition was administered to 52 patients.
Main Results:
- The majority of ECFs (68/70) were postoperative, with missile injury being the most common cause (42%).
- Conservative treatment healed 34 fistulas, while 10 required surgical intervention.
- Mortality rate was 35.7% (25/70), and one patient had treatment failure.
Conclusions:
- Missile injury is the predominant cause of ECF in this cohort.
- Duodenal and ileal fistulas showed better response to conservative management.
- High-output and jejunal fistulas were linked to adverse outcomes; Octreotide did not significantly alter results.
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