Nursing management of a viscerocutaneous fistula (original) (raw)
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Management of enterocutaneous fistulas
Clinics in colon and rectal surgery, 2004
Despite advances in antimicrobial chemotherapy, nutritional support, and perioperative critical care, the development of an enterocutaneous fistula continues to represent a major therapeutic challenge, with appreciable morbidity and mortality. Specific problems that must be addressed for the successful management of patients with enterocutaneous fistulas are the control of sepsis, maintenance of adequate fluid and electrolyte balance, provision of adequate and complication-free nutritional support, and skin-stoma care. In addition, many patients with postoperative intestinal fistulation suffer from significant psychological morbidity, which must be addressed during often prolonged periods of rehabilitation. The complex nature of the care required for successful management of patients with enterocutaneous fistulas mandates a multidisciplinary team approach, with specialist nurses, dieticians, pharmacists, radiologists, physicians, and surgeons all having important roles to play.
Current Management of Enterocutaneous Fistula
Journal of Gastrointestinal Surgery, 2006
Enterocutaneous fistulas, defined as abnormal communications between bowel and skin, are among the most challenging conditions managed by the general surgeon. In an era when the mortality from pancreaticoduodenectomy is less than 3%, the mortality of enterocutaneous fistulas remains 10 to 30% due to the often-present complications of sepsis, malnutrition, and electrolyte abnormalities. Taking advantage of recent advances in techniques of pre-and post-surgical management and support, employing a multidisciplinary team approach, and executing a well-delineated management plan provide the patient and surgeon with the best possibility of success in treating this potentially devastating condition. ( J GASTROINTEST SURG 2006;10:455-464) Ó
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.
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.