Enterocutaneous Fistula (GIT Fistula)

I had 2 ptz tat presented with enterocutaneous fistula in ward last 1 week. It is something tat i dint noe much... or better to say.. dont noe at all the management of the fistula. As always in the rounds.. Mr S asked us bout the fistula.. bout the classifications and the management and sort on.. We answered some.. and he told us to read thru it.. and the next day .. he taught us bout the fistula.. so here's the infos.. ;)

An intestinal fistula - an abnormal communication between two epithelialized surfaces. Gastrointestinal fistulas may form between the gastrointestinal tract and the skin (enterocutaneous) or an adjacent viscus (enteroenteral). They may be congenital or acquired. Primary (type-I) fistulas result from an underlying disease affecting the gut wall; secondary (type-II) fistulas occur after injury to otherwise normal gut.

Etiology - Spontaneous - Congenital
Specific Dzs - TB, Actinomycosis,
IBD - UC, Crohn's Dzs
Malignancy - Caecum Ca
Radiation
Medication - eg Steroid usage

- Post Operative - Anastomosis breakdown
Traumatic injury to the hollow organ intraop

Classification

1. Congenital @ Acquired
2. Spontaneous @ Postoperative(Traumatic)
3. Simple @ Complex
4. Low output @ Medium output @ High output
5. Small bowel @ Large Bowel

Scheme of Management of Enterocutaneous Fistula :
1. Rususcitation and control of the fistula discharge
2. Eliminate intra abdominal sepsis
3. Parenteral nutrition
4. Rehabilitation and ambulation
5. Definition of fistula and track
6. Definitive surgical treatment.

But thrs a simple way to remember the management.. told my Mr.S
4 R's
1. Resuscitation - rehydration of the ptz
replace fluid loss
correct acid base balance
correct electrolytes
2. Restitution ---> SNAP
Sepsis - threat the sepsis with antibiotics
Nutrition - keep ptz nil by mouth start parenteral nutrition
Anatomy - find the anatomy of the fistula and it communications., do a
fistulogram or US to find its wall and etc
Plan Procedure -combination of plan tat includes reducing the sepsis..
giving the ptx on parenteral nutrition... to noe the
characteristics of the fistula and to noe if the fistula will heal
spontaneously or need surgical intervention
3.Reconstrution - Plan for surgery to treat the fistula.. eg- laparatomy.. etc etc
4.Rehabilitation - Postoperative care ..to make reduce the complication such as multiple organ
failure, secondary fistula ptz mental state and so on.. ;) [No.3]