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Clin Colon Rectal Surg 2003; 16(3): 213-220
DOI: 10.1055/s-2003-42905
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Intestinal Fistulas

Clifford L. Simmang
  • University of Texas Southwestern Medical Center, Dallas, Texas
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Publikationsdatum:
10. Oktober 2003 (online)

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ABSTRACT

Enterocutaneous fistulas represent a very complex and life-threatening complication following surgery or as a result of a perforative disease process. At least half of the more common postoperative enterocutaneous fistulas will heal without further operations. However, the management involves a complex process of several phases. Following recognition of an enterocutaneous fistula, sepsis must first be controlled. Healing will be a lengthy process and nutrition must be begun early. Following stabilization of the patient, the fistula is investigated to define whether it is simple or complex and to demonstrate the anatomy. Several factors determine whether a given fistula is likely to heal or will ultimately require additional operations. For some fistulas, healing can be shortened by the use of adjunctive therapies such as vacuum-assisted wound care or fibrin glue infusion. For those fistulas that will require additional operations, the gold standard is resection of the involved intestines with primary anastomosis and repair of the abdominal wall defect. Other novel techniques may be useful for special situations. The successful treatment of an enterocutaneous fistula involves a methodical plan carefully evaluating each phase of management.

KEYWORDS

Enterocutaneous fistula - intestinal fistula - and postoperative complications

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