This document provides an overview of the management of enterocutaneous fistulas. It discusses the history, classification, etiology, pathophysiology, clinical presentation, investigation, management phases including stabilization, decision making, treatment, and prevention of enterocutaneous fistulas. The management involves correcting fluid and electrolyte imbalances, providing nutritional support, controlling sepsis, making a decision on definitive therapy after 4-6 weeks if not closing spontaneously, and surgical treatment when needed.

1. Management of Enterocutaneous Fistula Dr. Onkar Singh Department of surgery MY Hospital & MGM Medical College, Indore M.P.

18. Natural history Present absent Sepsis Crohn’s, cancer, foreign body, radiation Appendicitis, diverticulitis post operative Etiology malnourished Well nourished Nutritional status Gastric,ileal Esophageal, Duodenal stump, jejunal Anatomic location Unlikely to close Likely to close

19. Unlikely to close Likely to close <200mg/dl >200mg/dl transferrin epithelization Tract >2 cm Defect < 1cm 2 miscellaneous Total disruption,abscess,total obstruction, active disease. Healthy adjacent tissue, small leak,quiescence disease, no abscess. Condition of bowel

26. FISTULOGRAM

29. Entero-colic fistula

30. CT- Scan Entero colic fistula Sigmoid cutaneous fistula Gastro cutaneous fistula

32. Colonoscopy

33. Management phases for gastro intestinal fistulas 5-10 days after closure 5. Healing When spontaneous closure is unlikely or after 4-6 wks. 4. Definitive therapy 7-10 days to 4-6 wks. 3. Decision After 7-10 days 2. Investigation Within 24-48 hrs. 1. Stabilization

39. Wound pouch dressing

44. Central line

45. Recommended Nutritional Support 10mg/wk 10mg/wk Vitamin K Close watch Usually not needed Minerals 2RDA Vit C – 5 –10RDA RDA Vit C – 2RDA Vitamins Parenteral (20-30%) Enteral (20-30%) Lipids BEE x 1.5 BEE Calories 1.5-2.5g/kg/day 1-1.5g/kg/day Protein Usually Parenteral Enteral Form High Output Low Output

61. Operative procedure of fistula

62. Operated case of enterocutaneous fistula

70. THANKS