1. Wad medani teaching hospital
Pr: AHMED ALAMIN UNIT
By Dr:Adam Mohammed

2. Definition:it is an abnormal
communication between two epithelial
surfaces .
Congenital or acquired
Entero-
enteral fitula
EnterocutaniousF:an abnormal tract
communicating viscous with the skin
surface

3. Pathophysiology
Depends on the involved structres
High out put fistula =
malabsortion
Dehydration
Electrolytes abnormalities
Excoriation of the skin
Enterovesical fistula = recurrent UTI

4. Causes:
Emergency surgery Infections
Inflammatory bowel disease
Malignant diseases CAcolon
Intestinal anastomosis
Radiation enteritis
Trauma penetrating wounds
80 of entrocutaneous fistulas are
IATROGENIC

5. Classification:
Amount of discharge;high out put;>1 L/day
Low out put;<1L/day
Anatomical ;simple , complex
Nature of discharge:bile stained severe skin excoriation
Ileum or caecum; fluid faecal matter
Pancreatic;enzymes rich
Distal column solid or semisolid faeces

6. Clinical picture
Iatrogenic fistula initial signs
fever
leukocytosis
prolonged ileus
abd tenderness
wound infections
drainge of entric material from
wound or drains

7. Investigations:
Small bowel enema
Barium enema
Fistulogram
CTscan abdomen

8. Management: according to the type
Low out put;spontaneous closure ranging from 4-6-8WK
With TPN
High out put;skin protection ,rehydration,electrolytes
balance,defunctioning stoma,drugs(somatostatine),
operative repair

9. Factors that prevent spontaneous closure
Epithelialization epithelialization
Nature of the disease FRIEND
Foreign body or necrotic tissue
Distal obstruction
Dense fibrosis
Ischaemia
Drugs
Malnutrition
Irradiation
High out put,high pressure,inefficient drainage

10. prognosis
Depends on general condition of pt
the cause of fistula
the severity of fistula
mortality rate 10-15 due to sepsis –
underline disease
50 close spontaneously
more than 50 morbidity rate if
surgery for fistula done including 10
recurrence rate