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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Affiliations

1 Bradford Teaching Hospitals NHS trust, Leeds, United Kingdom

2 West Middlesex Hospital, London, United Kingdom

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Published

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Mistakes in ostomy management and how to avoid them

Revital Barkan, Ian White, Iris Dotan

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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

Ostomy management refers to the care and maintenance of an ostomy and involves various aspects to ensure the individual’s health, comfort, and quality of life. This should involve the patient, a close support system (family and/or friends), and a healthcare team, including ostomy nurses and healthcare professionals specialising in ostomy care.

Topics

Primary Care

Published

2025

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Abstract

Topics

Endoscopy

Published

2025

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Mistakes in the medical management of IBD and how to avoid them

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Summary

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Summary is not available for this content yet.

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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

Inflammatory bowel disease (IBD) affects approximately 0.5% to 1% of the population, a prevalence that challenges healthcare systems where it is too rare for primary care but common enough for general gastroenterologists. While some patients experience mild symptoms, others suffer from severe, disabling symptoms and unpredictable disease progression, necessitating a coordinated, multidisciplinary approach to management. Recent advances in understanding IBD pathogenesis, diagnostics, therapies, and surgical techniques have significantly changed IBD management. This Mistakes In article explores common pitfalls in treating IBD, highlighting the complexities and challenges faced by clinicians, and draws on evidence and clinical experience to suggest improvements in patient outcomes.

Topics

IBD

Citation

Raine T and Ding NS. Mistakes in the medical management of IBD and how to avoid them. UEG Education 2017; 17: 33–38.

Published

2024

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Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

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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

Topics

Hepatobiliary Surgery

Citation

Burra P and Zanetto A. Mistakes in liver transplantation and how to avoid them. UEG Education 2020; 2020: 1–6.

Published

2020

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