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Published on: March 12, 2019
Management of postoperative enterocutaneous fistulae in children: a decade experience in a single centre
Francis A Uba1, Stella C Uba, Emmanuel O Ojo
1Department of Surgery, Jos University Teaching Hospital, Plateau State, Nigeria. afranu@yahoo.com
Insights
Pediatric enterocutaneous fistula (ECF) management is challenging. High-protein nutrition aids spontaneous closure, but hypoalbuminemia and jejunal location predict poor outcomes and high mortality in children with ECF.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Critical Care Medicine
Background:
- Enterocutaneous fistula (ECF) in children presents significant management challenges, including sepsis, malnutrition, and fluid/electrolyte imbalances.
- Identifying prognostic factors for postoperative ECF is crucial for effective therapeutic strategies.
- This study investigated variables influencing the outcomes of pediatric ECF management.
Purpose of the Study:
- To identify prognostic factors for the management and outcomes of postoperative enterocutaneous fistulas in children.
- To analyze clinical features, management approaches, and outcomes in pediatric ECF cases.
- To determine factors associated with spontaneous closure, surgical closure success, morbidity, and mortality.
Main Methods:
- Retrospective evaluation of consecutive pediatric patients managed for postoperative ECF from 2000 to 2009.
- Analysis of clinical data, including fistula etiology, location, output, nutritional status, and management interventions.
- Statistical analysis to identify correlations between variables and ECF outcomes.
Main Results:
- Of 54 pediatric ECF patients, 53.7% achieved spontaneous closure; 38.9% required surgery, with only 22.2% success.
- High-output fistulas (jejunal location) strongly correlated with surgical closure (P<0.001).
- Hypoalbuminemia and jejunal location predicted non-spontaneous closure (P<0.001) and high morbidity (P<0.001); 24.1% mortality occurred due to hypokalemia, sepsis, and hypoproteinemia.
Conclusions:
- Most pediatric ECF cases resolve spontaneously with high-protein, high-carbohydrate nutrition.
- Hypoalbuminemia and jejunal location are key indicators of non-spontaneous closure.
- Hypokalemia, sepsis, and hypoproteinemia/hypoalbuminemia are significant risk factors for mortality in pediatric ECF.
Background:
Enterocutaneous fistula (ECF) in children poses a lot of management challenges due to sepsis, malnutrition, fluid and electrolyte deficits, which are frequent complications. Knowledge of prognostic factors of postoperative ECF is essential for therapeutic decision-making processes. This study examined the variables that relate to the outcomes of management of ECF in children.
Patients And Methods:
Consecutive children who were managed for postoperative ECF in our unit between 2000 and 2009 were evaluated. Data were analysed for clinical features, management and its outcome.
Results:
A total of 54 patients were managed for ECF. Majority of the fistulas were due to operation for infective causes, with typhoid intestinal perforation ranking the highest. Overall, spontaneous closure without operative intervention occurred in 29 (53.7%) patients. Twenty-one (38.9%) patients required restorative operations to close their fistulas, which was successful only in 12 (22.2%) patients. There was a strong correlation between high-output fistulas (jejunal location) and surgical closure (P<0.001). Hypoalbuminaemia and jejunal location profoundly resulted in non-spontaneous closure of ECF (P<0.001) and were associated with high morbidity (P<0.001). Thirteen (24.1%) patients died due to hypokalaemia, sepsis and hypoproteinaemia/hypoalbuminaemia.
Conclusions:
Majority of the ECF in children closed spontaneously following high-protein and high-carbohydrate nutrition. Hypoalbuminaemia and jejunal location were important prognostic variables resulting in non-spontaneous closure, while hypokalaemia, sepsis and hypoproteinaemia/hypoalbuminaemia were associated with high mortality in children with ECF.
