Evaluation of the outcome of conservative treatment of enterocutaneous fistulae (an optimistic result)‎ : 48 model Hospital, Sanna’a, Yemen

Abstract EN

management of enterocutaneous fistula represents surgical challenges in terms of morbidity and mortality.

In our study, such surgical challenges can be minimized to a lesser de-gree by adopting a meticulous team approach for spontaneous closure of the fistula.

Patients and Methods: during a period of four years, 49 cases of enterocutaneous fistulae arising from small and large intestines were managed, all of the fistulae resulted from surgical complications.

In 7/49 patients (14.2%) the fistulae arose from the proximal small gut (duodenum), in 5/49 (10.2%) the fis-tulae arose from the cecum.

1/49 patients (2%) from left colon and in the remaining 36/49 (73.6%) from the ileum.

Octreotide was used in all patients.

Peripheral partial nutrition (amino acids and hypertonic dextrose) was used in the first week, then partial enteral nutrition (fluids and semi fluids) to maintain the nutrition of the patients.

Results: Cases with enterocutaneous fistulae (n=49) were treated over a period of four years from august 2008 to august 2012 in 48 Model hospital.

There was only one female and 48 male patients with a mean age of 33 years (range from 19-50).

The main fistula output was 550 ml /day (range 150-1100ml/day).

16/49 patients (32.7%) had a high output fistula (> 400ml/day), where 12/16 cases were due to anastomosis leak and 4/16 cases due to missed injuries.

33/49 patients (67.3%) had a low output fistula; 6/33 patients (18.1%) missed large intestine and 27/33 patients (81.1%) missed injuries of the small intestine.

Conclusion: In our study, team work approach for conservative treatment for intestinal cutaneous fistulas that had been caused iatrogenically can lead to an optimistic results contrast studies do not con-tribute significantly to the ultimate outcome of the patients, rather than following an early surgi-cal line of management of an enterocutaneous fistulae specially when there is no clear contrain-dication for conservative approach, aiming for surgical closure of the fistula, we feel a meticulous team work approach hoping for spontaneous closure of the fistula, will lead to lesser morbidity and mortality with higher fistula closure rate.