ABSTRACT
Patients with inflammatory bowel disease (IBD) and especially Crohn's disease can
be challenging for even the most seasoned of surgeons. Development of an enterocutaneous
fistula (ECF) in these patients further adds a level of complexity that requires a
well-planned and defined management strategy. The role of the surgeon in caring for
these patients should be as the leader of a multidisciplinary team, directing the
care of the other specialists, all while determining if, and when, the patient requires
operative intervention. Although medical management has come a long way in these and
similar patients, surgery is still needed in a vast majority of patients. Therefore,
understanding the evaluation, initial management, and important technical considerations
for care of IBD and other complex patients with ECFs is a difficult, yet much needed,
task for which the surgeon should be prepared.
KEYWORDS
Enterocutaneous fistula - inflammatory bowel disease - Crohn's disease
REFERENCES
- 1
Datta V, Engledow A, Chan S, Forbes A, Cohen C R, Windsor A.
The management of enterocutaneous fistula in a regional unit in the United kingdom:
a prospective study.
Dis Colon Rectum.
2010;
53(2)
192-199
- 2
Berry S M, Fischer J E.
Classification and pathophysiology of enterocutaneous fistulas.
Surg Clin North Am.
1996;
76(5)
1009-1018
- 3
Mawdsley J E, Hollington P, Bassett P, Windsor A J, Forbes A, Gabe S M.
An analysis of predictive factors for healing and mortality in patients with enterocutaneous
fistulas.
Aliment Pharmacol Ther.
2008;
28(9)
1111-1121
- 4
Heller L, Levin S L, Butler C E.
Management of abdominal wound dehiscence using vacuum assisted closure in patients
with compromised healing.
Am J Surg.
2006;
191(2)
165-172
- 5
Khan J, Iiboshi Y, Cui L et al..
Alanyl-glutamine-supplemented parenteral nutrition increases luminal mucus gel and
decreases permeability in the rat small intestine.
JPEN J Parenter Enteral Nutr.
1999;
23(1)
24-31
- 6
Draus Jr J M, Huss S A, Harty N J, Cheadle W G, Larson G M.
Enterocutaneous fistula: are treatments improving?.
Surgery.
2006;
140(4)
570-576, discussion 576–578
- 7
Martinez J L, Luque-de-Leon E, Mier J, Blanco-Benavides R, Robledo F.
Systematic management of postoperative enterocutaneous fistulas: factors related to
outcomes.
World J Surg.
2008;
32(3)
436-443, discussion 444
- 8
Visschers R G, Olde Damink S W, Winkens B, Soeters P B, van Gemert W G.
Treatment strategies in 135 consecutive patients with enterocutaneous fistulas.
World J Surg.
2008;
32(3)
445-453
- 9
Lynch A C, Delaney C P, Senagore A J, Connor J T, Remzi F H, Fazio V W.
Clinical outcome and factors predictive of recurrence after enterocutaneous fistula
surgery.
Ann Surg.
2004;
240(5)
825-831
- 10
Bressler B, Sands B E.
Review article: medical therapy for fistulizing Crohn's disease.
Aliment Pharmacol Ther.
2006;
24(9)
1283-1293
- 11
Osterman M T, Lichtenstein G R.
Infliximab in fistulizing Crohn's disease.
Gastroenterol Clin North Am.
2006;
35(4)
795-820
- 12
Behm B W, Bickston S J.
Tumor necrosis factor-alpha antibody for maintenance of remission in Crohn's disease.
Cochrane Database Syst Rev.
2008;
(1)
CD006893
- 13
Poritz L S, Rowe W A, Koltun W A.
Remicade does not abolish the need for surgery in fistulizing Crohn's disease.
Dis Colon Rectum.
2002;
45(6)
771-775
- 14
Ferrante M, D'Hoore A, Vermeire S et al..
Corticosteroids but not infliximab increase short-term postoperative infectious complications
in patients with ulcerative colitis.
Inflamm Bowel Dis.
2009;
15(7)
1062-1070
- 15
Selvasekar C R, Cima R R, Larson D W et al..
Effect of infliximab on short-term complications in patients undergoing operation
for chronic ulcerative colitis.
J Am Coll Surg.
2007;
204(5)
956-962, discussion 962–963
- 16
Appau K A, Fazio V W, Shen B et al..
Use of infliximab within 3 months of ileocolonic resection is associated with adverse
postoperative outcomes in Crohn's patients.
J Gastrointest Surg.
2008;
12(10)
1738-1744
- 17
Goyer P, Alves A, Bretagnol F, Bouhnik Y, Valleur P, Panis Y.
Impact of complex Crohn's disease on the outcome of laparoscopic ileocecal resection:
a comparative clinical study in 124 patients.
Dis Colon Rectum.
2009;
52(2)
205-210
Guy R OrangioM.D.
Georgia Colon and Rectal Surgical Associates
P.C., 5555 Peachtree Dunwoody Rd. NE, Ste. 206, Atlanta, GA 30342
Email: gorangio@comcast.net
