The etiology of enterocutaneous fistula predicts outcome

Ochsner J. 2013 Winter;13(4):507-11.

Abstract

Background: The management of enterocutaneous fistula (ECF) provides a supreme challenge for the general surgeon.

Methods: We conducted a retrospective review of all cases of patients with ECF referred to the surgical service from July 2007 to June 2011 to achieve a better understanding of the factors that predict a successful outcome.

Results: A total of 35 patients were evaluated and managed in a systematic fashion that focused on treatment of abdominal sepsis, control of fistula output and wound management, nutritional optimization, and operative intervention when necessary. Age, gender, preoperative laboratory values, etiology of ECF, and prior abdominal surgery for ECF were reviewed and compared. Fisher exact test was used to compare patients who achieved a good outcome (n=23) to those with a poor outcome (n=12) to determine factors that might predict their ultimate result. Two factors that predicted poor outcome were the presence of abdominal malignancy (P=0.01) and ECFs that occurred in trauma patients with an open abdomen (P=0.03).

Conclusion: The etiology of ECF proved to be a more reliable predictor of outcome than clinical indicators.

Keywords: Intestinal fistula; parenteral nutrition—total; postoperative complications.