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

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

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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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Mistakes in coeliac disease diagnosis and how to avoid them

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Affiliations

1 University of Bologna, Italy

Summary

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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

Coeliac disease is an autoimmune disorder triggered by gluten, which activates an immune reaction against the autoantigen tissue transglutaminase (TG2) in genetically predisposed subjects. Genetic susceptibility to coeliac disease has been proven by its close linkage with major histocompatibility complex (MHC) class II human leukocyte antigen (HLA) DQ2 and DQ8 haplotypes. The identification of biomarkers for coeliac disease (e.g. endomysial antibodies [EmA] and antibodies to TG2 [anti-TG2]) has changed the epidemiology of coeliac disease from being a rare to a frequent condition, with an expected prevalence of 1% in the worldwide population. Coeliac disease can be difficult to diagnose because symptoms vary from patient to patient, and the majority of patients who have coeliac disease remain undiagnosed. Small intestinal biopsy remains the gold standard for coeliac disease diagnosis, and a delayed diagnosis in the elderly can be considered a risk factor for complications. Complicated coeliac disease is not so frequent, but for those who have it, the prognosis is very poor, with a low rate of survival after 5 years.

Topics

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Not sure what you can access? Learn more about account types.

Mistakes in mouse models of nonalcoholic steatophepatitis and how to avoid them

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Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

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

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.

Topics

Hepatobiliary

Citation

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

Published

2024

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