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Fistula

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Adam Ibrahim
Adam Ibrahim

This document defines and describes enteroenteric and enterocutaneous fistulas. It discusses their pathophysiology, causes, classifications, clinical presentation, investigations, management, factors preventing closure, and prognosis. Enteroenteric fistulas are abnormal connections between two epithelial surfaces that can be congenital or acquired. Enterocutaneous fistulas create an abnormal tract connecting the intestines to the skin surface. Management depends on the type and includes supportive care, defunctioning stomas, drugs, and operative repair. Prognosis depends on the patient's condition, cause, and severity of the fistula.

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Wad medani teaching hospital Pr: AHMED ALAMIN UNIT By Dr:Adam Mohammed
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
Pathophysiology Depends on the involved structres High out put fistula = malabsortion Dehydration Electrolytes abnormalities Excoriation of the skin Enterovesical fistula = recurrent UTI
Causes: Emergency surgery Infections Inflammatory bowel disease Malignant diseases CAcolon Intestinal anastomosis Radiation enteritis Trauma penetrating wounds 80 of entrocutaneous fistulas are IATROGENIC
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
Clinical picture Iatrogenic fistula initial signs fever leukocytosis prolonged ileus abd tenderness wound infections drainge of entric material from wound or drains
Investigations: Small bowel enema Barium enema Fistulogram CTscan abdomen
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
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
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
Fistula

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Fistula

  • 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