Considerations for the management of enterocutaneous fistula
Enterocutaneous fistula is an abnormal connection between the gastrointestinal tract and skin. Management includes early recognition and treatment of sepsis, reducing fluid and electrolyte homeostasis, nutrition support, wound management and a carefully timed surgical procedure. A multidisciplinary approach is required for successful management of these patients with one of the most challenging and resource-demanding aspects being local control of the effluent, requiring the skill and support of the specialist stoma care nurse. The inability to contain the fistula can be a source of morbidity for the patient, as they will experience pain and severe discomfort from the skin when leakages occur. Enterocutaneous fistula can result in intestinal failure, which is often fatal if not managed correctly.
Enterocutaneous fistula (ECF) occurs when there is an abnormal communication between the gastrointestinal (GI) tract and the skin. It may be caused by disease processes such as Crohn's disease, or iatrogenic (Dastur et al, 2015). Between 75% and 85% of ECFs are iatrogenic, resulting from trauma related to surgery. When fistulae occur in the small bowel about half are from an anastomotic leak and half from inadvertent injury to the small bowel during dissection (Gribovskaja-Rupp and Melton, 2016).
Initial efforts to manage ECF require input from the multidisciplinary team as success of further definitive surgical treatment relies on the patient being in optimal physical and psychological condition. The management involves reducing fluid losses, providing nutrients with fluids and treating the underlying cause and sepsis. Early wound management from a nurse specialist in stoma care is critically important to minimise the effluent-associated skin damage (Adaba et al, 2017).
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