Wad medani teaching hospitalPr: AHMED ALAMIN UNIT

By Dr:Adam Mohammed

Definition:it is an abnormal communication between two epithelial surfaces . Congenital or acquired

Entero-enteral fitula

EnterocutaniousF:an abnormal tract communicating viscous with the skin surface

Pathophysiology

Depends on the involved structresHigh out put fistula =

malabsortion Dehydration Electrolytes

abnormalities Excoriation of the skin Enterovesical fistula = recurrent UTI

Causes:Emergency surgery Infections

Inflammatory bowel disease

Malignant diseases CAcolon

Intestinal anastomosis

Radiation enteritis

Trauma penetrating wounds80 of entrocutaneous fistulas are

IATROGENIC

Classification:Amount of discharge;high out put;>1 L/day

Low out put;<1L/day

Anatomical ;simple , complex

Nature of discharge:bile stained severe skin excoriation

Ileum or caecum; fluid faecal matter

Pancreatic;enzymes rich

Distal column solid or semisolid faeces

Clinical picture

Iatrogenic fistula initial signsfever

leukocytosisprolonged ileus

abd tendernesswound

infections drainge of entric material from wound or drains

Investigations:

Small bowel enema

Barium enema

Fistulogram

CTscan abdomen

Management: according to the type

Low out put;spontaneous closure ranging from 4-6-8WK

With TPN

High out put;skin protection ,rehydration,electrolytes balance,defunctioning stoma,drugs(somatostatine), operative repair

Factors that prevent spontaneous closureEpithelialization epithelialization

Nature of the disease FRIEND

Foreign body or necrotic tissue

Distal obstruction

Dense fibrosis

Ischaemia

Drugs

Malnutrition

Irradiation

High out put,high pressure,inefficient drainage

prognosisDepends on general condition of pt

the cause of fistulathe severity of fistula

mortality rate 10-15 due to sepsis –underline disease

50 close spontaneouslymore than 50 morbidity rate if

surgery for fistula done including 10 recurrence rate