There are very few clinical studies that highlight a definitive and comprehensive guideline for the management of enterocutaneous fistulas. Most accepted guidelines are found in textbooks and are taken from expert advice and case reports. The goal of this review is to highlight advancements relevant to the management of enterocutaneous fistulas from the recent two to three years. Although strong evidence-based guidelines are lacking, the consensus is that a multidisciplinary team working with a clear treatment plan targeting multiple aspects of management can maximize patient outcomes.
Get full access to this article
View all access options for this article.
References
1.
ManosL.L., WolfgangC.L.The management of enterocutaneous fistulas.Current Surgical Therapy, 11th Ed.Philadelphia, PA: Saunders, an imprint of Elsevier Inc, 2014, pp. 142–5.
2.
TongC.Y., LimL.L., BrodyR.A.High output enterocutaneous fistula: a literature review and a case study.Asia Pac J Clin Nutr2012; 21: 464–9.
3.
KasparekM.S., BruckmeierA., BeigelF.Infliximab does not affect postoperative complication rates in Crohn's patients undergoing abdominal surgery.Inflamm Bowel Dis2012; 18: 1207–13.
4.
MajercikS., KinikiniM., WhiteT.Enteroatmospheric fistula: from soup to nuts.Nutr Clin Pract2012; 27: 507–12.
5.
SchecterW.P.Management of enterocutaneous fistulas.Surg Clin North Am2011; 91: 481–91.
6.
TeixeiraP.G., InabaK., DuboseJ.Enterocutaneous fistula complicating trauma laparotomy: a major resource burden.Am Surg2009; 75: 30–2.
7.
BjorckM., D'AmoursS.K., HamiltonA.E.Closure of the open abdomen.Am Surg2011; 77: S58–1.
8.
DavisK.G., JohnsonE.K.Controversies in the care of the enterocutaneous fistula.Surg Clin North Am2013; 93: 231–50.
9.
CollierB., GuillamondeguiO., CottonB.Feeding the open abdomen.JPEN J Parenter Enteral Nutr2007; 31: 410–5.
10.
PolkT.M., SchwabC.W.Metabolic and nutritional support of the enterocutaneous fistula patient: a three-phase approach.World J Surg2012; 36: 524–33.
11.
DudrickS.J., MaharajA.R., McKelveyA.A.Artificial nutritional support in patients with gastrointestinal fistulas.World J Surg1999; 23: 570–6.
12.
LynchA.C., DelaneyC.P., SenagoreA.J.Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery.Ann Surg2004; 240: 825–31.
13.
GuoY., GaoW., YangH.De-escalation of empiric antibiotics in patients with severe sepsis or septic shock: a meta-analysis.Heart Lung2016; 45: 454–9.
14.
DellingerR.P., LevyM.M., CarletJ.M.Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008.Crit Care Med2008; 36: 296–327.
15.
VisschersR.G., van GemertW.G., WinkensB.Guided treatment improves outcome of patients with enterocutaneous fistulas.World J Surg2012; 36: 2341–8.
16.
BleierJ.I., HedrickT.Metabolic support of the enter-ocutaneous fistula patient.Clin Colon Rectal Surg2010; 23: 142–8.
17.
UbaF.A., UbaS.C., OjoE.O.Management of postoperative enterocutaneous fistulae in children: a decade experience in a single centre.Afr J Paediatr Surg2012; 9: 40–6.
18.
KiyamaT., EfronD.T., TantryU., BarbulA.Effect of nutritional route on colonic anastomotic healing in the rat.J Gastrointest Surg1999; 3: 441–6.
19.
BragaM., GianottiL., GentiliniO.Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition.Crit Care Med2001; 29: 242–8.
20.
NovakF., HeylandD.K., AvenellA.Glutamine supplementation in serious illness: a systematic review of the evidence.Crit Care Med2002; 30: 2022–9.
21.
LloydD.A., GabeS.M., WindsorA.C.Nutrition and management of enterocutaneous fistula.Br J Surg2006; 93: 1045–55.
22.
StangaZ., BrunnerA., LeuenbergerM.Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment.Eur J Clin Nutr2008; 62: 687–94.
23.
WillcuttsK.The art of fistuloclysis: nutritional management of enterocutaneous fistulas.Pract Gastroenterol2010; 34: 47–56.
24.
TeubnerA., MorrisonK., RavishankarH.R.Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula.Br J Surg2004; 91: 625–31.
25.
HesseU., YsebaertD., de HemptinneB.Role of somatostatin-14 and its analogues in the management of gastrointestinal fistulae: clinical data.Gut2001; 49: iv11–21.
26.
Nubiola-CalongeP., BadiaJ.M., SanchoJ.Blind evaluation of the effect of octreotide (SMS 201-995), a somatostatin analogue, on small-bowel fistula output.Lancet1987; 2: 672–4.
27.
ScottN.A., FinneganS., IrvingM.H.Octreotide and postoperative enterocutaneous fistulae: a controlled prospective study.Acta Gastroenterol Belg1993; 56: 266–70.
28.
SanchoJ.J., di CostanzoJ., NubiolaP.Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula.Br J Surg1995; 82: 638–41.
GayralF., CampionJ.P., RegimbeauJ.M.Randomized, placebo-controlled, double-blind study of the efficacy of lanreotide 30 mg PR in the treatment of pancreatic and enterocutaneous fistulae.Ann Surg2009; 250: 872–7.
31.
RahbourG., SiddiquiM.R., UllahM.R.A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas.Ann Surg2012; 256: 946–54.
32.
LundyJ.B., FischerJ.E.Historical perspectives in the care of patients with enterocutaneous fistula.Clin Colon Rectal Surg2010; 23: 133–41.
33.
LeeS.H.Surgical management of enterocutaneous fistula.Korean J Radiol2012; 13: S17–20.
34.
AlexanderR.J., NashG.F.Enterocutaneous fistula stent.Ann R Coll Surg Engl2009; 91: 619–20.
35.
HeinemanJ.T., GarciaL.J., ObstM.A.Collapsible enteroatmospheric fistula isolation device: a novel, simple solution to a complex problem.J Am Coll Surg2015; 221: e7–14.
36.
KrpataD.M., SteinS.L., EstonM.Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown.Am J Surg2013; 205: 354–8; discussion 358–9.
37.
RamsayP.T., MejiaV.A.Management of enteroatmospheric fistulae in the open abdomen.Am Surg2010; 76: 637–9.
38.
SubramaniamM.H., LiscumK.R., HirshbergA.The floating stoma: a new technique for controlling exposed fistulae in abdominal trauma.J Trauma2002; 53: 386–8.
39.
SuliburkJ.W., WareD.N., BaloghZ.Vacuum-assisted wound closure achieves early fascial closure of open abdomens after severe trauma.J Trauma2003; 55: 1155–60; discussion 1160–51.
40.
ShaikhI.A., Ballard-WilsonA., YalamarthiS.Use of topical negative pressure in assisted abdominal closure does not lead to high incidence of enteric fistulae.Colorectal Dis2010; 12: 931–4.
41.
RaoM., BurkeD., FinanP.J.The use of vacuum-assisted closure of abdominal wounds: a word of caution.Colorectal Dis2007; 9: 266–8.
42.
BjarnasonT., MontgomeryA., EkbergO.One-year follow-up after open abdomen therapy with vacuum-assisted wound closure and mesh-mediated fascial traction.World J Surg2013; 37: 2031–8.
43.
FischerJ.E.A cautionary note: the use of vacuum-assisted closure systems in the treatment of gastrointestinal cutaneous fistula may be associated with higher mortality from subsequent fistula development.Am J Surg2008; 196: 1–2.
44.
MiskyA., HotourasA., RibasY.A systematic literature review on the use of vacuum assisted closure for enterocutaneous fistula.Colorectal Dis2016; 18: 846–51.
45.
AcostaS., BjarnasonT., PeterssonU.Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction.Br J Surg2011; 98: 735–43.
46.
LaytonB., DuboseJ., NicholsS.Pacifying the open abdomen with concomitant intestinal fistula: a novel approach.Am J Surg2010; 199: e48–50.
47.
OwenR.M., LoveT.P., PerezS.D.Definitive surgical treatment of enterocutaneous fistula: outcomes of a 23-year experience.JAMA Surg2013; 148: 118–26.
48.
de WeerdL., KjaeveJ., NergardS.The parachute design as a new extraperitoneal method of closing a recalcitrant high-output enterocutaneous fistula: report of a case.Surg Today2012; 42: 681–5.
49.
StephensenB., BrownJ., LambrianidesA.A novel method for managing enterocutaneous fistulae in the open abdomen using a pedicle flap.J Surg Case Rep2012; 2012: 5.
50.
LeeJ.K., SteinS.L.Radiographic and endoscopic diagnosis and treatment of enterocutaneous fistulas.Clin Colon Rectal Surg2010; 23: 149–60.
51.
MartinezJ.L., Luque-de-LeonE., Ballinas-OsegueraG.Factors predictive of recurrence and mortality after surgical repair of enterocutaneous fistula.J Gastrointest Surg2012; 16: 156–63; discussion 163–4.
52.
GecseK., KhannaR., StokerJ.Fistulizing Crohn's disease: diagnosis and management.United European Gastroenterol J2013; 1: 206–13.
53.
PrichayudhS., SriussadapornS., SamornP.Management of open abdomen with an absorbable mesh closure.Surg Today2011; 41: 72–8.
54.
ScholtesM., KurmannA., SeilerC.A.Intraperitoneal mesh implantation for fascial dehiscence and open abdomen.World J Surg2012; 36: 1557–61.
55.
LatifiR., JosephB., KulvatunyouN.Enterocutaneous fistulas and a hostile abdomen: reoperative surgical approaches.World J Surg2012; 36: 516–23.
56.
CarlsenB.T., FarmerD.G., BusuttilR.W.Incidence and management of abdominal wall defects after intestinal and multivisceral transplantation.Plast Reconstr Surg2007; 119: 1247–55; discussion 1256–8.
ZanfiC., CesconM., LauroA.Incidence and management of abdominal closure-related complications in adult intestinal transplantation.Transplantation2008; 85: 1607–9.
59.
MangusR.S., KubalC.A., TectorA.J.Closure of the abdominal wall with acellular dermal allograft in intestinal transplantation.Am J Transplant2012; 12: S55–9.
60.
GarciaA., BaldoniA.Complex ventral hernia repair with a human acellular dermal matrix and component separation: a case series.Ann Med Surg (Lond)2015; 4: 271–8.
61.
ScalaM., SpagnoloF., TrapassoM.Association of vacuum-assisted closure and platelet gel for the definitive surgical repair of an enterocutaneous fistula: a case report.In Vivo2012; 26: 147–50.