ABSTRACT
Enterocutaneous fistulas represent a very complex and life-threatening complication
following surgery or as a result of a perforative disease process. At least half of
the more common postoperative enterocutaneous fistulas will heal without further operations.
However, the management involves a complex process of several phases. Following recognition
of an enterocutaneous fistula, sepsis must first be controlled. Healing will be a
lengthy process and nutrition must be begun early. Following stabilization of the
patient, the fistula is investigated to define whether it is simple or complex and
to demonstrate the anatomy. Several factors determine whether a given fistula is likely
to heal or will ultimately require additional operations. For some fistulas, healing
can be shortened by the use of adjunctive therapies such as vacuum-assisted wound
care or fibrin glue infusion. For those fistulas that will require additional operations,
the gold standard is resection of the involved intestines with primary anastomosis
and repair of the abdominal wall defect. Other novel techniques may be useful for
special situations. The successful treatment of an enterocutaneous fistula involves
a methodical plan carefully evaluating each phase of management.
KEYWORDS
Enterocutaneous fistula - intestinal fistula - and postoperative complications
