Causes and management of postoperative enterocutaneous fistulas.

Abstract

OBJECTIVE:

To identify the causes of postoperative enterocutaneous fistulas and to evaluate the results of conservative and operative treatment including the effectiveness of octreotide in the management of these fistulas.

DESIGN:

A descriptive study.

PLACE AND DURATION OF STUDY:

Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro / Hyderabad between January 1997 and December 2001.

SUBJECTS AND METHODS:

Forty patients with postoperative fistula were studied. Demographic variables, causes and management outcome was observed and recorded.

RESULTS:

There were 25 males and 15 females with 50% of the patients being in age group of 21-30 years. Emergency surgery for typhoid perforation(45%) and intestinal tuberculosis (30%) were the commonest causes. Ileum and jejunum were the commonest sites of fistulation found in 85% cases. Twenty-one patients were started on conservative treatment with spontaneous closure occurring in 15 (71.4%) patients. Nineteen patients were operated within three days of admission due to generalized peritonitis (73.7%) and local intra-abdominal collections (26.3%). Wound infection was the commonest complication in the operative group. The mortality rate in this series was 7.5%. All the deaths occurred following surgery.

CONCLUSION:

Postoperative enterocutaneous fistula has a high morbidity and a significant mortality. Sepsis in the peritoneal cavity is the major cause of mortality. Conservative treatment has a good outcome for these fistulas. The use of octreotide is highly recommended as it definitely converts high output fistulas to low output fistulas.

• Authors: Abdul Sattar Memon, Faisal Ghani Siddiqui
• Journal: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP (J Coll Physicians Surg Pak) Vol. 14 Issue 1 Pg. 25-8 (Jan 2004) ISSN: 1022-386X [Print] Pakistan
• PMID: 14764257 (Publication Type: Journal Article)

Chemical References

• Gastrointestinal Agents
• Octreotide

Topics

• Adult
• Cutaneous Fistula (drug therapy, etiology, surgery)
• Female
• Gastrointestinal Agents (therapeutic use)
• Humans
• Intestinal Fistula (drug therapy, etiology, surgery)
• Male
• Octreotide (therapeutic use)
• Outcome Assessment, Health Care
• Postoperative Complications