Journal of the American College of Surgeons
Volume 209, Issue 4 , Pages 484-491 , October 2009

Enteric Fistulas: Principles of Management

Based on a presentation sponsored by the Committee on Perioperative Care at the American College of Surgeons 94th Annual Clinical Congress, San Francisco, CA, October 2008.

Received 6 April 2009 ,Revised 11 May 2009 ,Accepted 12 May 2009.

References 

  1. Evers M. Small intestine. In:  Townsend C,  Beauchamp R,  Evers BM,  Mattox K editor. Sabiston's textbook of surgery. 18th ed.. Philadelphia: Saunders Elsevier; 2008;p. 1324–1326
  2. Shrikhande GV. Enterocutaneous fistula. In:  Cameron JL editors. Current surgical therapy. Philadelphia: Elsevier Mosby; 2004;p. 134–140
  3. Beaumont W. Experiments and observations on the gastric juices and physiology of digestion. http://books.google.com/books?hl=en&id=H6F4_9joRkgC&dq=William+Beaumont+Alexis+St.+Martin&printsec=frontcover&source=web&ots=niBuha5ucX&sig=mLYnYspS-RUo5IZzD-14N15DGB94&sa=X&oi=book_result&resnum=19&ct=result#PPA17,M11Accessed January 19, 2009
  4. Alexis St Martin. http://en.wikipedia.org/wiki/Alexis St. MartinAccessed January 19, 2009.
  5. von Cackovic M. Ueber fistula des duodenum. Arch L Klin Chir. 1903;69:643
  6. Colp R. External duodenal fistulae. Ann Surg. 1923;78:725–744
  7. Bohrer JV, Milici A. Duodeno-cutaneous fistulae. Ann Surg. 1931;93:1174–1190
  8. Chapman R, Foran R. Management of intestinal fistulas. Am J Surg. 1964;108:157–164
  9. Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE. Can intravenous feeding as the sole means of nutrition support growth in the child and restore weight loss in an adult? (An affirmative answer). Ann Surg. 1969;169:974–984
  10. Sheldon GF, Gardiner BN, Way LW, Dunphy JE. Management of gastrointestinal fistulas. Surg Gynecol Obstet. 1971;133:385–389
  11. Hounsfield GN. Computerized transverse axial scanning (tomography). 1. Description of system. Br J Radiol. 1973;46:1016–1022
  12. Gerzof SG, Robbins AH, Birkett DH, et al. Percutaneous catheter drainage of abdominal abscesses guided by ultrasound and computed tomography. AJR Am J Roentgenol. 1979;133:1–8
  13. Mathes SJ, Bostwick J. A rectus abdominis myocutaneous flap to reconstruct abdominal wall defects. Br J Plast Surg. 1977;30:282–283
  14. Irving M, White R, Tresadern J. Three years' experience with an intestinal failure unit. Ann R Coll Surg Engl. 1985;67:2–5
  15. Levy E, Frileux P, Cugnenc PH, et al. [Exposed fistula of the small intestine, a complication of peritonitis or laparotomy (Apropos of 120 cases]). Ann Chir. 1986;40:184–195
  16. Schein M, Decker GA. Gastrointestinal fistulas associated with large abdominal wall defects: experience with 43 patients. Br J Surg. 1990;77:97–100
  17. Burch JM, Ortiz VB, Richardson RJ, et al. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215:476–483discussion 483−484
  18. Schein M. What's new in postoperative enterocutaneous fistulas?. World J Surg. 2008;32:336–338
  19. Edmunds LH, Williams GM, Welch CE. External fistulas arising from the gastro-intestinal tract. Ann Surg. 1960;152:445–471
  20. Berry SM, Fischer JE. Classification and pathophysiology of enterocutaneous fistulas. Surg Clin North Am. 1996;76:1009–1018
  21. Keighley M, Heyen F, Winslet MC. Entero-cutaneous fistulas and Crohn's disease. Acta Gastroenterol Belg. 1987;50:580–600
  22. Al-Khoury G, Kaufman D, Hirshberg A. Improved control of exposed fistula in the open abdomen. J Am Coll Surg. 2008;206:397–398
  23. Reber HA, Roberts C, Way LW, Dunphy JE. Management of external gastrointestinal fistulas. Ann Surg. 1978;188:460–467
  24. Visschers RG, Olde Damink SW, Winkens B, et al. Treatment strategies in 135 consecutive patients with enterocutaneous fistulas. World J Surg. 2008;32:445–453
  25. Dearlove JL. Skin care management of gastrointestinal fistulas. Surg Clin North Am. 1996;76:1095–1109
  26. Martinez JL, Luque-de-Leon E, Mier J, et al. Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes. World J Surg. 2008;32:436–443discussion 444
  27. Cro C, George KJ, Donnelly J, et al. Vacuum assisted closure system in the management of enterocutaneous fistulae. Postgrad Med J. 2002;78:364–365
  28. Banwell P, Withey S, Holten I. The use of negative pressure to promote healing. Br J Plast Surg. 1998;51:79
  29. Wainstein DE, Fernandez E, Gonzalez D, et al. Treatment of high-output enterocutaneous fistulas with a vacuum-compaction device (A ten-year experience). World J Surg. 2008;32:430–435
  30. Makhdoom ZA, Komar MJ, Still CD. Nutrition and enterocutaneous fistulas. J Clin Gastroenterol. 2000;31:195–204
  31. Nubiola P, Badia JM, Martinez-Rodenas F, et al. Treatment of 27 postoperative enterocutaneous fistulas with the long half-life somatostatin analogue SMS 201-995. Ann Surg. 1989;210:56–58
  32. Dorta G. Role of octreotide and somatostatin in the treatment of intestinal fistulae. Digestion. 1999;60:53–56
  33. Alivizatos V, Felekis D, Zorbalas A. Evaluation of the effectiveness of octreotide in the conservative treatment of postoperative enterocutaneous fistulas. Hepatogastroenterology. 2002;49:1010–1012
  34. Lattuada D, Casnici C, Crotta K, et al. Inhibitory effect of pasireotide and octreotide on lymphocyte activation. J Neuroimmunol. 2007;182:153–159
  35. Wiedermann CJ, Reinisch N, Braunsteiner H. Stimulation of monocyte chemotaxis by human growth hormone and its deactivation by somatostatin. Blood. 1993;82:954–960
  36. Wiedermann CJ, Reinisch N, Niedermuhlbichler M, Braunsteiner H. Inhibition of recombinant human growth hormone-induced and prolactin-induced activation of neutrophils by octreotide. Naunyn Schmiedebergs Arch Pharmacol. 1993;347:336–341
  37. Dudrick SJ, Maharaj AR, McKelvey AA. Artificial nutritional support in patients with gastrointestinal fistulas. World J Surg. 1999;23:570–576
  38. Lloyd DA, Gabe SM, Windsor AC. Nutrition and management of enterocutaneous fistula. Br J Surg. 2006;93:1045–1055
  39. Kudsk KA. Immunonutrition in surgery and critical care. Annu Rev Nutr. 2006;26:463–479
  40. Matheson PJ, Lusco V, Wilson MA, Garrison RN. Omega-3 fatty acids in immune-enhancing enteral diets selectively increase blood flow to the ileum by a bile acid dependent mechanism. Surgery. 2002;132:673–680discussion 680−671
  41. Bower RH, Cerra FB, Bershadsky B, et al. Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial. Crit Care Med. 1995;23:436–449
  42. Schilling J, Vranjes N, Fierz W, et al. Clinical outcome and immunology of postoperative arginine, omega-3 fatty acids, and nucleotide-enriched enteral feeding: a randomized prospective comparison with standard enteral and low calorie/low fat i. v. solutions. Nutrition. 1996;12:423–429
  43. Kudsk KA, Minard G, Croce MA, et al. A randomized trial of isonitrogenous enteral diets after severe trauma (An immune-enhancing diet reduces septic complications). Ann Surg. 1996;224:531–540discussion 540−533
  44. Pontes-Arruda A, Demichele S, Seth A, Singer P. The use of an inflammation-modulating diet in patients with acute lung injury or acute respiratory distress syndrome: a meta-analysis of outcome data. JPEN J Parenter Enteral Nutr. 2008;32:596–605
  45. Saffle JR, Wiebke G, Jennings K, et al. Randomized trial of immune-enhancing enteral nutrition in burn patients. J Trauma. 1997;42:793–800discussion 800−792
  46. Heyland DK, Novak F, Drover JW, et al. Should immunonutrition become routine in critically ill patients? (A systematic review of the evidence). JAMA. 2001;286:944–953
  47. Marik PE, Zaloga GP. Immunonutrition in critically ill patients: a systematic review and analysis of the literature. Intensive Care Med. 2008;34:1980–1990
  48. Stanga Z, Brunner A, Leuenberger M, et al. Nutrition in clinical practice-the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Eur J Clin Nutr. 2008;62:687–694
  49. Halversen RC, Hogle HH, Richards RC. Gastric and small bowel fistulas. Am J Surg. 1969;118:968–972
  50. Campos AC, Andrade DF, Campos GM, et al. A multivariate model to determine prognostic factors in gastrointestinal fistulas. J Am Coll Surg. 1999;188:483–490
  51. Fazio VW, Coutsoftides T, Steiger E. Factors influencing the outcome of treatment of small bowel cutaneous fistula. World J Surg. 1983;7:481–488
  52. Fischer JE. The pathophysiology of enterocutaneous fistulas. World J Surg. 1983;7:446–450
  53. Aguirre A, Fischer JE, Welch CE. The role of surgery and hyperalimentation in therapy of gastrointestinal-cutaneous fistulae. Ann Surg. 1974;180:393–401
  54. McIntyre PB, Ritchie JK, Hawley PR, et al. Management of enterocutaneous fistulas: a review of 132 cases. Br J Surg. 1984;71:293–296
  55. Prickett D, Montgomery R, Cheadle WG. External fistulas arising from the digestive tract. South Med J. 1991;84:736–739
  56. Sitges-Serra A, Jaurrieta E, Sitges-Creus A. Management of postoperative enterocutaneous fistulas: the roles of parenteral nutrition and surgery. Br J Surg. 1982;69:147–150
  57. Draus JM, Huss SA, Harty NJ, et al. Enterocutaneous fistula: are treatments improving?. Surgery. 2006;140:570–576discussion 576−578
  58. Hill GL. Operative strategy in the treatment of enterocutaneous fistulas. World J Surg. 1983;7:495–501
  59. Vianna RM, Mangus RS, Tector AJ. Current status of small bowel and multivisceral transplantation. Adv Surg. 2008;42:129–150
  60. Michelassi F, Stella M, Balestracci T, et al. Incidence, diagnosis, and treatment of enteric and colorectal fistulae in patients with Crohn's disease. Ann Surg. 1993;218:660–666
  61. Miehsler W, Reinisch W, Kazemi-Shirazi L, et al. Infliximab: lack of efficacy on perforating complications in Crohn's disease. Inflamm Bowel Dis. 2004;10:36–40
  62. Lynch AC, Delaney CP, Senagore AJ, et al. Clinical outcome and factors predictive of recurrence after enterocutaneous fistula surgery. Ann Surg. 2004;240:825–831
  63. Schecter WP, Ivatury RR, Rotondo MF, Hirshberg A. Open abdomen after trauma and abdominal sepsis: a strategy for management. J Am Coll Surg. 2006;203:390–396
  64. Scott BG, Feanny MA, Hirshberg A. Early definitive closure of the open abdomen: a quiet revolution. Scand J Surg. 2005;94:9–14
  65. Girard S, Sideman M, Spain DA. A novel approach to the problem of intestinal fistulization arising in patients managed with open peritoneal cavities. Am J Surg. 2002;184:166–167
  66. Sarfeh IJ, Jakowatz JG. Surgical treatment of enteric ‘bud’ fistulas in contaminated wounds (A riskless extraperitoneal method using split-thickness skin grafts). Arch Surg. 1992;127:1027–1030discussion 1030−1021
  67. Subramaniam MH, Liscum KR, Hirshberg A. The floating stoma: a new technique for controlling exposed fistulae in abdominal trauma. J Trauma. 2002;53:386–388
  68. Boulanger K, Lemaire V, Jacquemin D. Vacuum-assisted closure of enterocutaneous fistula. Acta Chir Belg. 2007;107:703–705
  69. Rao M, Burke D, Finan PJ, Sagar PM. The use of vacuum-assisted closure of abdominal wounds: a word of caution. Colorectal Dis. 2007;9:266–268
  70. Fischer JE. 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 Surg. 2008;196:1–2
  71. Jamshidi R, Schecter WP. Biological dressings for the management of enteric fistulas in the open abdomen: a preliminary report. Arch Surg. 2007;142:793–796
  72. Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defects: acute and long-term results. Ann Surg. 2003;238:349–355discussion 355−347
  73. Shestak KC, Edington HJ, Johnson RR. The separation of anatomic components technique for the reconstruction of massive midline abdominal wall defects: anatomy, surgical technique, applications, and limitations revisited. Plast Reconstr Surg. 2000;105:731–738quiz 739
  74. Maurice SM, Skeete DA. Use of human acellular dermal matrix for abdominal wall reconstructions. Am J Surg. 2009;197:35–42
  75. Hsu PW, Salgado CJ, Kent K, et al. Evaluation of porcine dermal collagen (Permacol) used in abdominal wall reconstruction. J Plast Reconstr Aesthet Surg 2008 Aug 19. [Epub ahead of print].
  76. Johnson EK, Paquette EL. Use of surgisis for abdominal wall reconstruction/closure in battlefield casualties during Operation Iraqi Freedom. Mil Med. 2007;172:1119–1124
  77. de Moya MA, Dunham M, Inaba K, et al. Long-term outcome of acellular dermal matrix when used for large traumatic open abdomen. J Trauma. 2008;65:349–353
  78. Jin J, Rosen MJ, Blatnik J, et al. Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes?. J Am Coll Surg. 2007;205:654–660
  79. Williams JK, Carlson GW, deChalain T, et al. Role of tensor fasciae latae in abdominal wall reconstruction. Plast Reconstr Surg. 1998;101:713–718
  80. Koshima I, Moriguchi T, Inagawa K, Urushibara K. Dynamic reconstruction of the abdominal wall using a reinnervated free rectus femoris muscle transfer. Ann Plast Surg. 1999;43:199–203
  81. de Weerd L, Kjaeve J, Aghajani E, Elvenes OP. The sandwich design: a new method to close a high-output enterocutaneous fistula and an associated abdominal wall defect. Ann Plast Surg. 2007;58:580–583

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PII: S1072-7515(09)00510-9

doi: 10.1016/j.jamcollsurg.2009.05.025

Journal of the American College of Surgeons
Volume 209, Issue 4 , Pages 484-491 , October 2009