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TREATMENT AND CAUSES OF ENTEROCUTANOUS FISTULA

Dr Roma Raj, Dr Ayesha Syed Iftikhar, Dr Aqsa Syed Iftikhar

Objective: To investigate the different causes, common location and different treatment methods of enterocutaneous fistula. Study design: A Descriptive study. Place and Duration: In the Surgical department of Liaquat National Hospital Karachi for one year duration from June 2018 to June 2019. Methods: Twenty-two patients underwent enterocutaneous fistula following trauma surgery, abdominal tuberculosis, ileal perforation, gynecological cause, perforated appendicitis, gastric perforation and stoma conversion. Patients with malignant disease were excluded from the study. All patients were initially treated conservatively. Patients who did not respond were operated. All patients were followed up after discharge and closely monitored for recurrent leaks and other complications. Results: Of the 22 patients, 14 (64%) were male and 8 (36%) had a M: F ratio of 1.7: 1. Their ages ranged from 18 to 62 years, with an average of 40 years. Most of the patients belong to the 41-50 age group. Initial surgical indications were abdominal tuberculosis 10 (45%), gynecological surgery in 3 (14%) cases, reverse stoma 2 (09%), FAI (febrile arm injury) 2 (09%), closed abdominal trauma 2 (09%), perforated appendicitis 2 (09%) and gastric perforation 1 (5%). 16 (73%) fistulas were having high results and 6 (27%) have low. Nine (41%) patients responded to conservative treatment whereas 13 (59%) patients did not. The causes of enterocutaneous fistula (surgical findings) were anastomotic leak / repair in 7 (31%) patients and missed perforation in 6 (27%) patients. The most common fistula region was ileum in 13 (59%), colon in 4 (18%), blind in 2 (09%), jejunum in 2 (09%) and stomach in 1 (05%). Five patients died at a mortality rate of 23%. Conclusion: Intestinal tuberculosis was the most common cause of enterocutaneous fistula affecting the small intestine. Anastomotic / repair leakage was the most common surgical finding after detection. Key Words: Enterocutaneous Fistula, Tuberculosis, Anastomosis Leaks.

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