Mistakes in the management of enterocutaneous fistulae and how to avoid them

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Mistakes in the management of enterocutaneous fistulae and how to avoid them

Simon Lal, Jonatan Epstein, Philip Allan

Summary

AI Generated

Gastrointestinal fistulae are challenging complications that create abnormal connections between the gut and other organs, tissues, or skin, causing malnutrition, infection, and significant impact on quality of life.

Gastrointestinal fistulae are abnormal tracts connecting the epithelialised gut surface to another part of the gut, another organ or tissue, or to the skin.
These connections can cause enteric contents to bypass absorptive surfaces, resulting in malnutrition or diarrhoea, infection in other organs, or faeculant material appearing in the vagina or on the skin.
Fistulae have a major impact on quality of life, psychological wellbeing, and overall prognosis in terms of general health.
Multidisciplinary management includes stoma management, medical therapies to control output, nutritional support, and surgery, which plays a central role in resolving fistulae.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lal S, et al. Review article: intestinal failure. Aliment Pharmacol Therapeut 2006; 24: 19–31. [Link]

Rahbour G, et al. A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas Ann Surg 2012; 256: 946–954. [Link]

Amiot A, et al. Long-term outcome of enterocutaneous fistula in patients with Crohn's disease treated with anti-TNF therapy: a cohort study from the GETAID. Am J Gastroenterol 2014; 109: 1443–1449. [Link]

Visschers RG, et al. Treatment strategies in 135 consecutive patients with enterocutaneous fistulas. World J Surg 2008; 32: 445–453.

Scripcariu V, et al. Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection. Br J Surg 1994; 81: 1475–1478.

Visschers RG, et al. Guided treatment improves outcome of patients with enterocutaneous fistulas. World J Surg 2012; 36: 2341–2348.

Abstract

Gastrointestinal fistulae can be one of the most challenging complications of intestinal disease to manage. These abnormal tracts connect the epithelialised gut surface to either another part of the gut, another organ or tissue, or to the skin (table 1). This connection can cause enteric contents to bypass important absorptive surfaces, resulting in insidious malnutrition or overt diarrhoea, infection within other organs or the exquisitely embarrassing occurrence of having faeculant material in a woman’s vagina or on a person’s skin. Understandably, this can have a major impact on a person’s quality of life and psychological wellbeing and hamper overall prognosis in terms of general health and wellbeing. Through careful multidisciplinary management of the situation much can be done to address the fears and expectations of patients: careful stoma management, medical therapies to control output, nutritional support and consideration of the central role that surgery plays in resolving a fistula.

Topics

Small Intestine & Nutrition Surgery

Citation

Cite this article as: Allan P, Epstein J and Lal S. Mistakes in enterocutaneous fistulae management and how to avoid them. UEG Education 2019; 19: 19–21.

Published

2019

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lal S, et al. Review article: intestinal failure. Aliment Pharmacol Therapeut 2006; 24: 19–31. [Link]

Rahbour G, et al. A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas Ann Surg 2012; 256: 946–954. [Link]

Visschers RG, et al. Treatment strategies in 135 consecutive patients with enterocutaneous fistulas. World J Surg 2008; 32: 445–453.

Scripcariu V, et al. Reconstructive abdominal operations after laparostomy and multiple repeat laparotomies for severe intra-abdominal infection. Br J Surg 1994; 81: 1475–1478.

Visschers RG, et al. Guided treatment improves outcome of patients with enterocutaneous fistulas. World J Surg 2012; 36: 2341–2348.

Abstract

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Topics

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Lal S, et al. Review article: intestinal failure. Aliment Pharmacol Therapeut 2006; 24: 19–31. [Link]

Rahbour G, et al. A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas Ann Surg 2012; 256: 946–954. [Link]

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Visschers RG, et al. Guided treatment improves outcome of patients with enterocutaneous fistulas. World J Surg 2012; 36: 2341–2348.

Abstract

Nonalcoholic fatty liver disease (NAFLD) is a growing cause of chronic liver disease worldwide that can manifest as nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis (NASH). Compared with NAFL, NASH poses a substantially higher risk of progression to advanced liver disease, cirrhosis and hepatocellular carcinoma (HCC). Given the lack of directed pharmacological therapies and the complex, multifactorial disease aetiology and pathology, NAFLD is expected to become the leading cause of end-stage liver disease in the coming decades.

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Castro RE and Diehl AM. Mistakes in animal models of nonalcoholic steatohepatitis and how to avoid them. UEG Education 2018; 18: 30–34

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Affiliations

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2 West Middlesex Hospital, London, United Kingdom

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