Nursing management of a viscerocutaneous fistula (original) (raw)
Vacuum assisted closure system in the management of enterocutaneous fistula
Postgraduate Medical Journal, 2002
Background: There is controversy in the use of vacuum assisted closure therapy (VAC) in management of enterocutaneous fistula (ECF). Due to the increased risk of new fistula formation, its use was contraindicated, but then several studies reported successful closure, fistula effluent control and healing of excoriated skin by keeping it dry. Objectives: The aim of this study is to evaluate the efficacy of VAC in treatment of the complex postoperative ECF. Patient and Methods: Patients with postoperative ECF were enrolled in this prospective study in the period from January 2018 to June 2019. Full history, examination and investigations were done for all patients. Patients had VAC. After one month, responses to VAC in terms of time from fistula to VAC, general condition, fistula output, fistula closure, wound size, skin condition, time to start oral feeding, need to segregate, complications and mortality were recorded. On follow-up, time to complete closure, type of closure and cost were recorded. Results were then analyzed. Results: 60 patients with ECF were enrolled. General condition was improved in 32 patients while ECF output was improved in 52 patients. Early start of Oral feeding had occurred with the use of VAC. Complications as pain, new fistula formation, pulmonary embolism or ongoing sepsis occurred in 40 patients while mortality occurred in 12 patients. Conclusion: VAC is feasible in complex postoperative enterocutaneous fistulae. It enhances the survival, improves the general condition and the perifistular skin and reduces the fistula output and wound size.
Historical perspectives in the care of patients with enterocutaneous fistula
Clinics in colon and rectal surgery, 2010
Evidence can be found throughout surgical history of how devastating an enterocutaneous fistula (ECF) can be for both patient and surgeon. From antiquity, this complication of abdominal surgery, malignancy, radiation, trauma, or inflammatory processes has been a significant challenge to surgeons due to high associated mortality and significant morbidity. An ECF causes dehydration, malnutrition, skin excoriation, and sepsis, and has profound psychological effects on the patient. Recent mortality rates of patients suffering an ECF approach 20%. The authors illustrate the history of management of patients with ECF and discuss advances in perioperative care including parasurgical care, nutrition, wound care, and the history of surgical techniques.
Current concepts in the management of enterocutaneous fistula
International Surgery Journal, 2018
Enterocutaneous fistula is an abnormal connection between the intra-abdominal gastrointestinal tract and skin. It causes considerable morbidity and mortality. The goals of management are restoration of gastrointestinal continuity and allowance of enteral nutrition with minimal morbidity and mortality. A multidisciplinary approach is essential in the successful management and this has led to closure rates ranging from 5-20% following conservative management and 75-85% with operative treatment. This article seeks to review the current concepts in the management of enterocutaneous fistula. A systematic search of literature on enterocutaneous fistula was conducted. Relevant materials were selected and selected references from relevant books, journal articles and abstracts using Medline, Google scholar and Pubmed databases were critically reviewed. Enterocutaneous fistulas can be classified by the anatomy, aetiology or physiology. Anatomically, enterocutaneous fistula has been classified based on the organ of origin and this is useful in the consideration of management options: type l (abdominal oesophageal and gastroduodenal fistula), type ll (small bowel fistula), type lll (large bowel fistula) and type IV (enteroatmospheric, regardless of origin. The anatomy also depends on the presence or absence of associated abscess cavity and the length and characteristics of the fistula tract. Aetiologically, the majority of enterocutaneous fistulas are iatrogenic (75-85%) while between 15 and 25% occur spontaneously. The physiological classification is based on the volume of its output. High output fistulas drain more than 500mls in 24 hours, moderate output between 200 and 500mls in 24 hours and low output less than 200mls in 24 hours. Successful management requires a multidisciplinary approach and would consist of initial resuscitaion with fluids and electrolytes, control of sepsis, good and adequate nutrition, wound care and skin protection and definitive management. The treatment of enterocutaneous fistula is multidisciplinary and remains a challenge despite the recent improvement in supportive care. Once enterocutaneous fistula occurs, adequate stabilization of the patient and non-operative management should be commenced. If surgery is required, careful planning, meticulous dissection, restoration of bowel continuity and reconstruction of abdominal wall are critical.
Current Management of Enterocutaneous Fistulas
Ain Shams Journal of Surgery, 2016
Background: Enterocutaneous fistulas are abnormal communications between the gastrointestinal tract and the skin. More than 75% of all ECFs arise as a postoperative complication, while about 15-25% of them result from abdominal trauma or occur spontaneously. Fistulas are defined by their sites of origin, communication and flow. Aim of the work: This paper reviews our experience in the treatment of enterocutaneous fistulas to evaluate current management practice and outcome. Patients and methods: This retrospective study was conducted on 40 patients with enterocutaneous fistulas treated at El-Demerdash, Ain -Shams University Specialized hospitals in Cairo, Egypt and Alazhar Hospital in Riyadh, KSA during the period from March 2011 to March 2015. Thirty patients (75 %) were males and 10 patients (25%) were females. Their ages ranged between 30 and 50 years. Results: 95% of fistulas resulted from previous surgery and 5% after trauma. Fifty percent (50%) of the fistulas were high-output, 25% were intermediate-output fistulas and 25% were low-output fistulas. Conservative treatment was successful in 10 patients (25%) and all of them (100%) closed spontaneously while 30 patients (75%) had to be surgically explored and twenty seven patients (90%) were closed after surgery. The overall mortality rate was 10%. It was concluded from this study, that surgical intervention was indicated in high-output fistulas and fistulas which fail to close with conservative management. Low-output fistulas usually require no surgery and mostly close with conservative treatment.
Al-Azhar International Medical Journal
Background: There is controversy in the use of vacuum assisted closure therapy (VAC) in management of enterocutaneous fistula (ECF). Due to the increased risk of new fistula formation, its use was contraindicated, but then several studies reported successful closure, fistula effluent control and healing of excoriated skin by keeping it dry. Objectives: The aim of this study is to evaluate the efficacy of VAC in treatment of the complex postoperative ECF. Patient and Methods: Patients with postoperative ECF were enrolled in this prospective study in the period from January 2018 to June 2019. Full history, examination and investigations were done for all patients. Patients had VAC. After one month, responses to VAC in terms of time from fistula to VAC, general condition, fistula output, fistula closure, wound size, skin condition, time to start oral feeding, need to segregate, complications and mortality were recorded. On follow-up, time to complete closure, type of closure and cost were recorded. Results were then analyzed. Results: 60 patients with ECF were enrolled. General condition was improved in 32 patients while ECF output was improved in 52 patients. Early start of Oral feeding had occurred with the use of VAC. Complications as pain, new fistula formation, pulmonary embolism or ongoing sepsis occurred in 40 patients while mortality occurred in 12 patients. Conclusion: VAC is feasible in complex postoperative enterocutaneous fistulae. It enhances the survival, improves the general condition and the perifistular skin and reduces the fistula output and wound size.
Vacuum Assisted Closure (VAC): A Promising Therapeutic Tool for Enterocutaneous Fistulas
Managing an enterocutaneous fistula continues to pose the greatest challenge to the general surgeon. Aggressive supportive care is pivotal in managing these patients. Vacuum assisted closure (VAC) therapy is a promising therapeutic tool for such patients. It undoubtedly helps in closure of the fistula thus avoiding the high morbidity and mortality associated with surgical intervention. A case of a complex enterocutaneous fistula treated by VAC therapy is presented.
Clinical study of enterocutaneous fistula
International Surgery Journal, 2017
Background: An enterocutaneous fistulae (ECF) may be challenging to manage due to the large volume of fluid losses, that may result in severe dehydration, electrolyte imbalances, malnutrition and sepsis. It is imperative that this group of patients receive adequate nutrition, as malnutrition and sepsis are the leading cause of death.Methods: This descriptive study was conducted prospectively in the Department of Surgery between September 2004 and August 2010. Patients whom develop ECF after surgery were included in the study while patients with esophageal, biliary, pancreatic, and perianal fistulas were excluded. The description of fistula included cause, anatomical location, fistula output, complications, and outcome. Fistula output was quantified by direct measurement, in the presence of drain or by calculating number of dressing pads soaked per day. To examine the statistical significance of association between attributes, Chi-square test and Fisher's exact test were used. A ...
Guided Treatment Improves Outcome of Patients with Enterocutaneous Fistulas
World Journal of Surgery, 2012
Background The present study was designed to evaluate the effects of guided treatment of patients with an enterocutaneous fistula and to evaluate the effect of prolonged period of convalescence on outcome. Methods All consecutive patients with an enterocutaneous fistula treated between 2006 and 2010 were included in this study. Patient information was gathered prospectively. Treatment of patients focused on sepsis control, optimization of nutritional status, wound care, establishing the anatomy of the fistula, timing of surgery, and surgical principles. Outcome included spontaneous and surgical closure, mortality, and postoperative recurrence. The relationship between period of convalescence and recurrence rate was determined by combining the present prospective cohort with a historical cohort from our group. Results Between 2006 and 2010, 79 patients underwent focused treatment for enterocutaneous fistula. Cox regression analysis showed that period of convalescence related significantly with recurrence of the fistula (hazard ratio 0.99; 95 % confidence interval 0.98-0.999; p = 0.04). Spontaneous closure occurred in 23 (29 %) patients after a median period of convalescence of 39 (range 7-163) days. Forty-nine patients underwent operative repair after median period of 101 (range 7-374) days and achieved closure in 47 (96 %). Overall, eight patients (10 %) died. Conclusions Prolonging period of convalescence for patients with enterocutaneous fistulas improves spontaneous closure and reduces recurrence rate.