ECF

Question 1

A 50- year- old female presents persistent discharge just above the umbilicus following an exploratory laparotomy with adhesiolysis and resection anastomosis of small bowel done for acute intestinal obstruction.

Q1: What’s your diagnosis?

Answer 1

Most probably ECF

Question 2

Q2: What’s the definition of an enterocutaneous fistula?

Answer 2

abnormal communication between the epithelial lining of GIT and the skin lined by granulation tissue.
FISTULA: abonormal communication btw 2 epithelial surfaces lined by granulation tissue

Question 3

Q3: How fistulas are classified?

Answer 3

ConGenital
Acquired
Etiological– inflammatory, infectious, cancerous
Location – entero-entric or EC - EV
High - intermediate - low output

Question 4

Q4: What’s the most common cause of ECF?

Answer 4

Iatrogenic following anastomotic leakage

Question 5

Q5: What are the predisposing factors?

Answer 5

IBD , Carcinoma, irradiation, ischemia, infection

Question 6

Q6: What are the complications of ECF?

Answer 6

Sepsis
Electrolyte disturbances
Malnutrition
Skin complications

Question 7

Q7: What could bring a patient with ECF to the OR?

Answer 7

Distal obstruction
Intra-abd sepsis

Question 8

Q8: If the patient developed nausea, vomiting, swinging pyrexia, abdominal tenderness and rigidity. What is your diagnosis?

Answer 8

Intra-abd sepsis

Question 9

Q9: How would you manage this patient intially?

Answer 9

CCRISP
SNAP control
Mgmt; control sepsis – > sepsis 6
Nutritional support after discussion with nutritionist and giving TPN
Anatomical assesment for fistula and protect skin
Planned surgery

Question 10

Q10: How would you manage nutrition in such patient?

Answer 10

After discussion with nutritionist I will give this pt TPN
I will measure the calories , usually he takes around 45 kcal/kg/day
Ptns , fat and glucose and minerals

Question 11

Q11: When would you consider surgical correction of ECF?

Answer 11

If pt is going in sepsis or signs of peritonitis or not responding to conserve management

Question 12

Q12: What are the factors that could prevent a fistuala from healing spontaneously?

Answer 12

Pt; presence of malignancy, Crohn’s, presestant pathology, malnutrition or anemia
Local; High output fistula, fistula track is long > 2 cm , defect > 1 cm , infection, distal obstruction.

Question 13

Q13: What are the radiological modalities that can be utilized for assesing ECF?

Answer 13

Fistulogram, contrast CT scan