Enterocutaneous fistula
An enterocutaneous fistula (ECF) is an abnormal communication between the small or large bowel and the skin that allows the contents of the stomach or intestines to leak through an opening in the skin.[1]
Causes
The mnemonic HIS FRIENDS can be used to memorize characteristics which impede the closure of ECF.[2]
H: high output I: IBD S:short tract
- F Foreign body
- R Radiation
- I Infection or Inflammatory bowel disease
- E Epithelialization
- N Neoplasm
- D Distal obstruction
- S Short tract (<2 cm)
Diagnosis
Classification
Congenital types: tracheoesophageal, vitellointestinal duct, patent urachus, rectovaginal
Acquired: trauma (postoperative), radiation, malignancy, infection
Two categories
Low-output fistula: < 500 mL/day
High-output fistula: > 500 mL/day
Three categories
Low-output fistula: < 200 mL/day
Moderate-output fistula: 200–500 mL/day
High-output fistula: > 500 mL/day[3]
Treatment
The majority will close spontaneously within approximately 6 weeks. If it has not closed by 12 weeks, it is unlikely to do so and definitive surgery should be planned. The median time to definitive repair from fistula onset was 6 months (range 1 day to 28 months). The 6-month time course is commonly utilized by groups with significant experience treating fistulas, owing to the trend in encountering a less hostile abdomen than in the early phases.[4] Some evidence also suggests that somatostatin can be an effective treatment with respect to reducing closure time and improving the spontaneous closure rate of enterocutaneous fistulas.[5]
References
- "Gastrointestinal fistula". MedlinePlus. Retrieved 5 November 2014.
- Lee SH (2012). "Surgical management of enterocutaneous fistula". Korean Journal of Radiology. 13 Suppl 1: S17–S20. doi:10.3348/kjr.2012.13.S1.S17. PMC 3341456. PMID 22563283.
- Galie KL, Whitlow CB (2006). "Postoperative enterocutaneous fistula: when to reoperate and how to succeed". Clinics in Colon and Rectal Surgery. 19: 237–246. doi:10.1055/s-2006-956446. PMC 2780112. PMID 20011327.
- Ross H (2010). "Operative surgery for enterocutaneous fistula". Clinics in Colon and Rectal Surgery. 23: 190–194. doi:10.1055/s-0030-1262987. PMC 2967319. PMID 21886469.
- Stevens, P; Foulkes, RE; Hartford-Beynon, JS; Delicata, RJ (October 2011). "Systematic review and meta-analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula". European Journal of Gastroenterology & Hepatology. 23 (10): 912–922. doi:10.1097/MEG.0b013e32834a345d. PMID 21814141.
- Metcalf C (1999). "Enterocutaneous fistulae". Journal of Wound Care. 8 (3): 141–142. doi:10.12968/jowc.1999.8.3.25854.