Chapter 46: Fistulas- Enterocutaneous

Question 1

What is it?

Answer 1

Fistula from GI tract to skin (enterocutaneous = bowel to skin)

Question 2

What are the causes?

Answer 2

• Anastomotic leak
• trauma/injury to the bowel/colon
• Crohn’s disease
• abscess
• diverticulitis
• inflammation/infection
• inadvertent suture through bowel

Question 3

What is the workup?

Answer 3

1. CT scan to rule out abscess/inflammatory process
2. Fistulagram

Question 4

What are the possible complications?

Answer 4

• High-output fistulas
• malnutrition
• skin breakdown

Question 5

What is the treatment?

Answer 5

• NPO
• TPN
• drain abscesses
• rule out and correct underlying causes
• may feed distally
  
  • or if fistula is distal, feed elemental diet proximally)
• half will close spontaneously
  
  • but the other half require operation and resection of the involved bowel segment

Question 6

Which enterocutaneous fistula closes faster: short or long?

Answer 6

Long fistula