Anantha Ramani Pratha1, Konkena Janardhana Rao2, Kalyani Adiraju3, Ramprakash Gurram4, Saikrishna Katakam5
Enterocutaneous fistulas are a surgeon’s nightmare, more so if they occur after one’s own surgery. They are a challenge, testing the surgeon’s patience and expertise. Their management remains a team work. The success depends on the wellbeing of the patient during this great ordeal of management. In this article, we are reviewing and presenting the experience gained by us while managing 58 cases of enterocutaneous fistulas.
We have studied the causes, the time of occurrence, the duration of conservative treatment, the methods of investigations and definitive treatment and ultimate outcome of our management of 58 cases of postoperative enterocutaneous fistulas, in a period of 5 years. Total 58 cases, postoperative enterocutaneous fistulas were the most common type (75%), 4 lost for follow-up. All fistulas were initially managed conservatively. Patients were maintained on total parenteral nutrition, evaluated for the cause and site of leak. High output fistulas were made as controlled fistula by diverting the loop to exterior following stabilisation, to minimise spillage and sepsis. Low output fistulas explored and definitive treatment carried out if there is persistent leak after 8 weeks. 8 ileal fistulas healed spontaneously (13.7%). 3 malignant rectal fistulas sent for radiotherapy. Initial damage control surgery was done in 15 cases (ileal+sigmoid+rectum) (25.86%). Definitive surgery was done in 39 cases (67%). Out of 54 cases, 15 expired-(27.7%)
