Literature Review – Enterocutaneous Fistulas
Upon reviewing three peer-reviewed, research articles on enterocutaneous fistulas, it was
found that the rates of mortality and morbidity are extremely high in patients with this condition
and that nutrition management and vigilant postoperative care and wound management are
crucial for patient care. Each article represented different studies focusing on surgical
management, nutrition care, and correct post-operative strategies for wound care.
The first study focused on nutritional support in managing malnutrition, sepsis, and fluid
and electrolyte imbalances in individuals with enterocutaneous fistulas and determining what
factors influence clinical outcomes.1 Nutrition management was determined on the location of
the fistula and data was collected from 22 patients at the Universiti Kebangsaan Medical Center.1
It was found that surgery and sepsis are the main reasons for the high mortality rate in these
patients and there was a significant relationship between the length of stay and nutrition support.1
It was determined that maintaining nutritional status in patients with enterocutaneous fistulas is
crucial in the healing process, conservative management, and in preparation for surgical repair.1
The second study compared the outcomes of patients with enterocutaneous fistulas
between conservative and surgical treatments.2 The study focused on 83 patients at Providence
Hospital from the years 1997 – 2007.2 Out of these patients, 72% were postoperative, 79.5%
were initially treated with conservative measures, 20.5% underwent initial surgery, and 18
patients did not respond to conservative treatments and required secondary treatments.2
Throughout the entire study, fistulas were aided in closure with the use of ocreotide, wound
VAC’s, and fibrin glue.2 It was found that there was not a significant difference in outcomes
between surgical and conservative management but that conservative management improved the
nutritional status and wound management of the patients with both low and high output fistulae.2
The last study focused on surgical outcomes of enterocutaneous fistulas through
morbidity and mortality rates.3 The study found that uniform surgical managements are limited
and allow for differences in preoperative preparation, operative technique and skill level, and
postoperative care/wound management in patients.3 For this study, 153 patient charts from
Emory University Hospital from the years 1897-2010 were analyzed.3 The only stipulation for
patient participation was the patient had to have had surgical treatment for an enterocutaneous
fistula originating in the stomach, small bowel, colon, and rectum under a single surgeon.3 It was
found that 83.7% of the patients had successful closures, 3.9% died within 30 days of surgery,
overall 1-year mortality was 15%, and overall morbidity rate was 87.6%.3 It was also found that
postoperative ventilation longer than 48 hours, surgical site infections, and blood transfusions
within 72 hours of surgery were the highest risk factors for mortality.3 Proper enterocuatneous
fistula management minimizes complications after surgery, encourages proper fistula closure,
and maintains the overall health status of the patient.3
Overall, proper nutrition management, proper surgical and conservative care, and
postoperative care are required for proper enterocutaneous fistula healing. A form of nutrition
care should be implemented as soon as medically feasible in order to prevent malnutrition,
sepsis, and electrolyte imbalances. Due to the high mortality and morbidity rates with this
population, appropriate pre-operative and post-operative care needs to be implemented to insure
the best outcomes. The medical team handling this population need to be very knowledgeable
and aware of new research and care techniques in order to provide the best health care and
outcomes for the patient.
References
1. Badrasawi MH, Shahar S, Sagap I. Nutritional management of enterocutaneous fistula: a
retrospective study at a Malaysian university center. Journal of Multidisciplinary Healthcare.
2014; 7: 365-370.
2. Taggarshe D, Bakston D, Jacobs M, McKendrick A, Mittal VK. Management of
enterocutaneous fistulae: A 10 year experience. World Journal of Gastrointestinal Surgery.
2010; 2:242-246.
3. Own RM, Love TP, Perez SD, Srinivasan JK, Sharma J, Polluck JD, Haack CI, Sweeney JF,
Galloway JR. Definitive Surgical Treatment of Enterocutaneous Fistula. Jama Surgical. 2013;
148: 118-126.