ENTEROCUTANEOUS FISTULAS - 1
Enterocutaneous fistulas (ECFs) are abnormal communications between the bowel and
skin (two epithelialized surfaces).
A feared complication accompanied by intraabdominal abscesses and sepsis with a
morality rate of 6.5 to 21%.
Most commonly post-operatively after inflammatory bowel disease, cancer, or lysis of
Usually iatrogenic surgical misadventure (85-90%): anastomotic leakage (roughly half),
inadvertent enterotomy during lysis of adhesions or closure (roughly half)
15% - 25% occur spontaneously (Crohn’s disease, neoplasm, infectious, radiation,
Crohn’s disease (CD)
o Transmural inflammation of CD leads to bowel adherence to adjacent structures
→ microperforation → abscess → fistula (usually to bowel, bladder, or vagina)
o Fistulas develop in 20-40% of patients with CD, one half-internal, one-half
external of which most are ECF.
o Post-appendectomy fistulas arise from terminal ileum where active CD adheres to
abdominal suture line.
Prolonged ileus, febrile, erythematous wound → enteric contents (usually between POD
5 and 10)
Confirmation with oral charcoal or Congo red, UGI, fistulogram, or endoscopy.
CT scan to detect underlying collections
More proximal fistulas have greater fluid and electrolyte loss, nutritional handicap.
o Foreign body, Radiation, Inflammation/infection, Epithelialization, Neoplasm,
Likely to close
Unlikely to Close
Oropharyngeal, esophageal, duodenal stump,
Gastric, lateral duodenal, ligament of
Nutritional status Well nourished
Healthy adjacent tissue, small leak, no
abscess, quiescent disease
Total disruption, distal obstruction,
abscess, active disease
Epitheliazation, foreign body
o Low (<200cc/24 hours), moderate (200-500cc/24 hour