References

Adaba F, Vaizey CJ, Warusavitarne J. Management of intestinal failure: the high-output enterostomy and enterocutaneous fistula. Clin Colon Rectal Surg. 2017; 30:(3)215-222 https://doi.org/10.1055/s-0037-1598163

Association of Stoma Care Nurses UK. ASCN stoma care national clinical guidelines. 2016. https://bit.ly/2ksJKd8 (accessed 25 February 2018)

Baxter H, Ballard K Vacuum Assisted Closure Nursing Times. 2001; 97:(35)51-2

Dastur JK, Nachiappan S, Maeda Y, Warusavitarne J, Vaizey C. PWE-229 Innovations in enterocutaneous fistula management: a systematic review [Abstract from 2nd Digestive Disorders Federation Conference]. Gut. 2015; 64:A312-A313 https://doi.org/10.1136/gutjnl-2015-309861.675

Grainger JT, Maeda Y, Donnelly SC, Vaizey CJ. Assessment and management of patients with intestinal failure: a multidisciplinary approach. Clin Exp Gastroenterol. 2018; 11:233-241 https://doi.org/10.2147/ceg.s122868

Gribovskaja-Rupp I, Melton GB. Enterocutaneous fistula: proven strategies and updates. Clin Colon Rectal Surg. 2016; 29:(2)130-137 https://doi.org/10.1055/s-0036-1580732

Nightingale JMD. The medical management of intestinal failure: methods to reduce the severity. Proc Nutr Soc. 2003; 62:(3)703-710 https://doi.org/10.1079/pns2003283

Pironi L, Arends J, Baxter J ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr. 2015; 34:(2)171-180 https://doi.org/10.1016/j.clnu.2014.08.017

Considerations for the management of enterocutaneous fistula

14 March 2019
13 min read
Volume 28 · Issue 5

Abstract

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).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content