Enterocutaneous Fistula Treatment
Useful Enterocutaneous Fistula Cure
Fluid electrolyte imbalance, sepsis and malnutrition are the main cause of death in patient suffering with enterocutaneous fistula (ECF). The mortality rates have reduced considerably since the early 80’s to 40 to 65 % high to 5 to 20%. This is because due to the largely result in advances of operative techniques, wound care, antimicrobial therapy, nutritional support and intensive care. On the other hand, the mortality rates are somewhat high in rage especially in patients with high-output of ECF.
Principles of Therapy
Included in the principles of therapy or treatment for enterocutaneous fistula are skin protection, control of the fistula drainage, nutritional support, drainage of the obvious abscess, electrolyte repletion, correction of anemia, antibiotic administration and rehydration. The above discussed spontaneous closure and supportive therapy, there are about 70% of patient received this type of treatment. In the recent study, it shows that at least 91 % did so after a month of treating sepsis.
As you know, enteral nutrition is the basis of treating ECF.As mentioned fistulas of duodenum, colon, and distal ileum must be considered and may be administered by several routes. Usually, when gastro duodenal anastomosis or the closure is required in adverse conditions, an associated feeding jejunostomy is conducted to have an access on the support of nutrition in case of anastomostic leak.
Moreover, some routes of administration could also be via jejuna/nasogastric tubes or gastrostomy. The high-rates of feeding must be avoided in order to prevent hyperosmolar diarrhea. An elemental diet which is non-residue balanced diet together with protein is reduced to their elements.
Skin care management
The skin care management is based on the location of the fistula opening, condition of the skin, nature of effluent and origin fistula.
In case of high-output fistula, it is preferred a pouch system which is basically preferable in a conservative skin dressing. In low output fistula, skin barrier with a dressing pouch is supported. The level of skin irritation present guides on the skin protecting agents must be applied on the type of pouch system that would be used. If the opening is flush into the skin, deep, retracted, which is close to the bony prominences or open wound is also essential information.
Pouches used for skin care
If the fistula output is high, it is ideal to use pouch in order to collect enteric effluents. As you know, ostomy pouches in one or two designs with ant urostomy or drainable clip closes could be cut and fit into the perisfistular skin. If area is within the irregular contour of the body close to bony prominences then 1 piece pouch is more ideal, hence it could adhere better.
According to nlm.nih.gov enterocutaneous fistula is considered to be the most difficult condition that can affect a person.