A ten-year review of enterocutaneous fistulas after laparotomy for trauma

J Trauma. 2009 Nov;67(5):924-8. doi: 10.1097/TA.0b013e3181ad5463.


Background: In the era of open abdomen management, the complication of enterocutaneous fistula (ECF) seems to be increasing in frequency. In nontrauma patients, reported mortality rates are 7% to 20%, and spontaneous closure rates are approximately 25%. This study is the largest series of ECFs reported exclusively caused by trauma and examines the characteristics unique to this population.

Methods: Trauma patients with an ECF at a single regional trauma center over a 10-year period were reviewed. Parameters studied included fistula output, site, nutritional status, operative history, and fistula resolution (spontaneous vs. operative).

Results: Approximately 2,224 patients received a trauma laparotomy and survived longer than 4 days. Of these, 43 patients (1.9%) had ECF. The rate of ECF in men was 2.22% and 0.74% in women. Patients with open abdomen had a higher ECF incidence (8% vs. 0.5%) and lower rate of spontaneous closure (37% vs. 45%). Spontaneous closure occurred in 31% with high-output fistulas, 13% with medium output, and 55% with low output. The mortality rate of ECF was 14% after an average stay of 59 days in the intensive care unit.

Conclusion: With damage-control laparotomies, the traumatic ECF rate is increasing and is a different entity than nontraumatic ECF. Although the two populations have similar mortality rates, the trauma cohort demonstrates higher spontaneous closure rates and a curiously higher rate of development in men. Fistula output was not predictive of spontaneous closure.

MeSH terms

  • Abdominal Injuries / surgery*
  • Adult
  • Female
  • Humans
  • Incidence
  • Injury Severity Score
  • Intestinal Fistula / epidemiology
  • Intestinal Fistula / etiology*
  • Laparotomy
  • Male
  • Postoperative Complications / epidemiology
  • Treatment Outcome
  • Wounds, Nonpenetrating / surgery*
  • Wounds, Penetrating / surgery*