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Persistent postoperative enterocutaneous fistula: pathophysiology and treatment
The Australian and New Zealand Journal of Surgery
|December 1, 1986
Summary
Postoperative enterocutaneous fistulas often persist due to distal bowel obstruction. Surgical lysis of adhesions, assuming obstruction, successfully treated 21 of 23 patients with these difficult-to-heal fistulas.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Abdominal Surgery
Background:
- Enterocutaneous fistulas are complex postoperative complications.
- Causes like inflammatory bowel disease or irradiation are excluded.
- The etiology of persistent fistulas post-abdominal surgery is often unclear.
Purpose of the Study:
- To investigate the role of distal obstruction in enterocutaneous fistula persistence.
- To propose a surgical strategy for treating postoperative enterocutaneous fistulas.
Main Methods:
- Postulated distal obstruction (adhesions/abscess) as the key factor.
- Proposed surgical intervention based on the assumption of distal obstruction.
- Included complete lysis of adhesions involving small and large bowel.
Main Results:
- A surgical approach assuming distal obstruction was employed.
- 21 out of 23 patients with postoperative enterocutaneous fistula were cured.
- The 'venting' effect of fistulas can mask underlying obstruction.
Conclusions:
- Distal bowel obstruction is a critical determinant of enterocutaneous fistula persistence.
- Surgical treatment should prioritize complete lysis of adhesions to address presumed obstruction.
- This strategy offers a high success rate for curing postoperative enterocutaneous fistulas.