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Related Experiment Videos

Colocutaneous fistulas complicating diverticulitis.

V W Fazio, J M Church, D G Jagelman

    Diseases of the Colon and Rectum
    |February 1, 1987
    PubMed
    Summary

    Diversion of the fecal stream reduces morbidity in colonic fistulas. Proper colorectal anastomosis and considering Crohn's disease are crucial for successful diverticulitis treatment.

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    Area of Science:

    • Gastroenterology
    • Colorectal Surgery
    • Surgical Outcomes

    Background:

    • Colocutaneous fistulas are a complication of diverticulitis, often requiring surgical intervention.
    • Fistula formation can occur spontaneously or, more commonly, post-operatively.
    • Patient factors like weight loss and hypoalbuminemia were noted but did not impact outcomes.

    Purpose of the Study:

    • To review outcomes of patients with colocutaneous fistulas associated with diverticulitis.
    • To identify factors influencing fistula persistence and surgical success.
    • To evaluate the role of fecal diversion and surgical techniques in managing these fistulas.

    Main Methods:

    • Retrospective review of 93 patients with colocutaneous fistulas treated between 1965 and 1983.

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  • Analysis of patient demographics, fistula characteristics, surgical interventions, and outcomes.
  • Statistical evaluation of factors influencing morbidity and success rates.

    • Main Results:

    • Eighty-eight of 93 fistulas followed surgery; five were spontaneous. Diverting stomas reduced morbidity but did not prevent formation.
    • High-output fistulas (greater than 200 cc/day) had worse outcomes.
    • Sepsis and distal colon issues were key factors in fistula persistence. Surgery achieved stoma/fistula-free status in 77% of cases.
    • Crohn's disease (10 patients) and carcinomas (5 patients) were associated with poorer outcomes.

    Conclusions:

    • Diversion of the fecal stream is vital for reducing morbidity in colonic fistulas.
    • Performing a true colorectal anastomosis after diverticulitis resection is essential.
    • Crohn's disease should be considered in patients with complicated clinical courses.