The entero-
cutaneous fistulas (ECF) are abnormal communications between intestine and abdominal skin. They can occur spontaneously, or after an injury or a
surgical procedure. They are associated with a high rate of morbidity and mortality. Spontaneous
fistulas can mainly occur in patients affected by
cancer,
inflammatory bowel disease,
diverticulitis,
appendicitis, as a result of
radiotherapy or
injuries.
Surgical procedures, carried out in case of neoplastic diseases,
inflammatory bowel disease, adhesions removal, represent the primary cause in the development of a postoperative
fistulas.
Malnourishment, poor general conditions of the patient, high output
fistula along with anatomical site of development, and the presence of
abscesses, represent the negative factors influencing the
spontaneous healing of
fistulas. The experience reported here is about three ECF cases occurred after surgery and treated only with medical
therapy. The first case is a woman in good general conditions who underwent surgery to remove a recurrent retroperitoneal
myxoid liposarcoma situated in the right lower quadrant. The patient had never undergone surgery for an intestinal resection. The other two patients analyzed were affected by
sepsis and metabolic unbalance and had developed a
fistula after colonic resection. Fluids and
electrolytes adjustments and
sepsis management have preceded any other kind of
therapy. Continuous infusion with
somatostatin, fast,
proton pump inhibitors and
loperamide have been taken up to decrease secretions and intestinal motility.
Total parenteral nutrition has been essential to recover nutritional status and improve patients' general conditions. In order to heal and protect peri-
fistula skin we have used sterile washing solutions, absorbable ionic exchange resin,
silver and
polyurethanes based medications and
colostomy bags adhesive systems. Since surgical treatment of ECF is associated with high rates of morbidity and mortality,
conservative treatment should always be taken into consideration. When
conservative treatment fails, delayed surgical intervention has been related to a higher rate of success. The purpose of this study is to describe diagnostic and therapeutic guidelines to general surgeons, like ourselves, whenever they have to deal with ECF cases.