Department of Surgery, Manipal College of Medical Sciences, Fulbari, Pokhara, Nepal.
JNMA J Nepal Med Assoc. 2022 Jan 15;60(245):93-100. doi: 10.31729/jnma.5780.
Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin, etc. Enterocutaneous fistula can occur after any gastrointestinal surgery where there is some trauma during surgery or other associated causes such as malignancy, inflammatory bowel disease, foreign body, etc. Enterocutaneous fistula needs a multidisciplinary approach as its management is a very tedious and complex process. Sepsis, malnutrition, and dyselectrolytemia are three key factors during the management of enterocutaneous fistula, so these should be properly addressed for better and efficient outcomes. There is excess fistula effluent which should be replaced adequately in high output fistula. The nutrition of the patient plays a vital role in the success of enterocutaneous fistula management so if the patient can tolerate oral or enteral feeding should be commenced as soon as possible otherwise parenteral nutrition should be advised. Wound care should be done aggressively, proper skincare, timely drainage of any localised abscesses should be done. Patients should be properly resuscitated and stabilised before any definitive investigations and management. Surgical therapy can be staged and should not be rushed which results in failure of this complex disease process.
肠外瘘是指肠腔与体表或体腔之外其他空腔脏器之间存在异常通道。肠外瘘可以根据病因、起源器官等多种方式进行分类。肠外瘘可发生于任何胃肠道手术后，手术过程中存在一些创伤或其他相关原因，如恶性肿瘤、炎症性肠病、异物等。肠外瘘的管理需要多学科的方法，因为其管理是一个非常繁琐和复杂的过程。在肠外瘘的管理中，败血症、营养不良和电解质紊乱是三个关键因素，因此应该妥善处理这些因素，以获得更好和更有效的结果。对于高流量瘘，应该适当补充多余的瘘液。患者的营养在肠外瘘管理的成功中起着至关重要的作用，因此，如果患者能够耐受口服或肠内喂养，应尽快开始，如果不能耐受，则应建议给予肠外营养。应积极进行伤口护理，妥善护肤，及时引流任何局部脓肿。在进行任何明确的检查和管理之前，患者应得到适当的复苏和稳定。手术治疗可以分期进行，不应匆忙进行，否则会导致这一复杂疾病过程的失败。
