The pathophysiology of enterocutaneous fistulas |
| |
Authors: | Josef E. Fischer M.D. |
| |
Affiliation: | 1. Department of Surgery, University of Cincinnati Medical Center, 45221, Cincinnati, Ohio, USA
|
| |
Abstract: | The patient with an enterocutaneous fistula represents a high-risk situation with overall mortality rates of up to 20%, depending on the series. Treatment of these patients to a successful outcome requires attention to detail and, if necessary, meticulous operative technique. For convenience, care of these patients is divided into 5 phases: - Stabilization. Resuscitation with crystalloid colloid and/or blood. Drainage of only obvious abscesses. Beginning of local wound care. Initiation of nutritional support.
- Investigation. Radiographic investigation of local fistula area, principally by sinography and, if necessary, other contrast studies. Purpose of these studies is to determine likelihood of spontaneous closure with nutritional support.
- Decision. Is operation indicated and, if so, when? A decision must be made as to the necessity for operative closure in situations in which the fistula appears anatomically favorable but shows no signs of closure.
- Definitive therapy—either spontaneous closure or operation. If the latter, careful preparation is required. Resection and end-to-end anastomosis gives the best results.
- Healing phase. Nutritional support should not be discontinued too soon for fear of breakdown of newly laiddown protein.
With experience and proper management, relatively high success rates can be achieved. |
| |
Keywords: | |
本文献已被 SpringerLink 等数据库收录! |
|