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External fistulas arising from the digestive tract.

D Prickett1, R Montgomery, W G Cheadle

  • 1Department of Surgery, University of Louisville School of Medicine, Ky.

Southern Medical Journal
|June 1, 1991
PubMed
Summary

Managing external abdominal fistulas, often from gastrointestinal surgery leaks, requires infection control, nutritional support, and wound care. Successful closure significantly improves outcomes, while persistent fistulas are linked to higher mortality.

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Abdominal Surgery

Background:

  • External abdominal fistulas originating from the digestive tract present significant challenges, including high mortality and morbidity.
  • These fistulas commonly result from anastomotic leaks following gastrointestinal surgery.

Purpose of the Study:

  • To review the management and outcomes of patients with external abdominal fistulas.
  • To identify key principles for successful fistula closure and patient survival.

Main Methods:

  • Retrospective review of 58 patients with external abdominal fistulas over a 5-year period.
  • Analysis of fistula origin, output, complexity, management strategies, and patient outcomes.

Main Results:

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  • The study identified fistulas from the stomach, duodenum, small intestine, colon, biliary tract, and pancreas.
  • High-output fistulas ( > 200 mL/day) and multiple fistulas were common.
  • Closure was achieved in 48 patients; 80% of patients with open fistulas died, contributing to an overall mortality of 19%.

    • Conclusions:

    • Effective management involves controlling infection, correcting imbalances, providing nutritional support, and wound care.
    • Operative intervention, including staged procedures for complex cases, is often necessary.
    • Fistula closure is the primary goal, requiring patience and comprehensive management for improved survival.