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Enterocutaneous fistulas following laparotomy for trauma
K J Buechter1, D Leonovicz, P R Hastings
1Department of Surgery, Louisiana State University Medical Center, New Orleans 70112.
The American Surgeon
|June 1, 1991
Summary
Traumatic enterocutaneous fistulas (ECF) can heal spontaneously with nutritional support. However, many patients require surgery due to sepsis or lack of healing, indicating traditional ECF management principles apply to post-traumatic cases.
Area of Science:
- Gastroenterology
- Surgical Complications
- Trauma Surgery
Background:
- Enterocutaneous fistulas (ECF) are known complications of gastrointestinal diseases.
- Trauma is an infrequent cause of ECF.
- Postoperative fistulas can significantly impact patient recovery and healthcare costs.
Purpose of the Study:
- To evaluate the applicability of traditional ECF management principles in post-traumatic ECF.
- To assess spontaneous healing rates and indications for operative intervention in traumatic ECF.
- To analyze fistula origin in relation to initial abdominal injury.
Main Methods:
- Retrospective study of 15 patients with post-traumatic ECF.
- Analysis of management strategies, including nutritional support and operative intervention.
- Evaluation of fistula healing outcomes and associated complications like sepsis.
Main Results:
- One-third (33%) of post-traumatic ECF cases achieved spontaneous closure with nutritional support alone.
- Two-thirds (66%) of patients necessitated surgical intervention.
- Indications for surgery included associated sepsis or failure of spontaneous fistula healing.
- Five fistulas originated from uninjured bowel segments.
Conclusions:
- Established principles for managing enterocutaneous fistulas are effective for post-traumatic ECF.
- Nutritional support can lead to spontaneous closure in a significant minority of cases.
- Sepsis is a primary driver for early, aggressive surgical treatment of traumatic ECF.