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JNMA; Journal of the Nepal Medical... Jan 2022Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin,... (Review)
Review
Enterocutaneous fistula is any communication between bowel and skin or atmosphere outside the body. It can be classified by various means by etiology, organ of origin, etc. Enterocutaneous fistula can occur after any gastrointestinal surgery where there is some trauma during surgery or other associated causes such as malignancy, inflammatory bowel disease, foreign body, etc. Enterocutaneous fistula needs a multidisciplinary approach as its management is a very tedious and complex process. Sepsis, malnutrition, and dyselectrolytemia are three key factors during the management of enterocutaneous fistula, so these should be properly addressed for better and efficient outcomes. There is excess fistula effluent which should be replaced adequately in high output fistula. The nutrition of the patient plays a vital role in the success of enterocutaneous fistula management so if the patient can tolerate oral or enteral feeding should be commenced as soon as possible otherwise parenteral nutrition should be advised. Wound care should be done aggressively, proper skincare, timely drainage of any localised abscesses should be done. Patients should be properly resuscitated and stabilised before any definitive investigations and management. Surgical therapy can be staged and should not be rushed which results in failure of this complex disease process.
Topics: Drainage; Enteral Nutrition; Humans; Intestinal Fistula; Malnutrition; Sepsis
PubMed: 35199684
DOI: 10.31729/jnma.5780 -
Tissue Barriers Apr 2022Fistula treatment represents a major unmet medical need in the therapy of Crohn's disease (CD). Current medical therapies, such as anti-TNF antibody treatments, are...
Fistula treatment represents a major unmet medical need in the therapy of Crohn's disease (CD). Current medical therapies, such as anti-TNF antibody treatments, are often insufficient and do not achieve permanent fistula closure. Previously published data point toward a critical role for metalloproteinase-9 (MMP-9)/gelatinase B in fistula pathogenesis. The aim of this project was to investigate in detail MMP-9 expression in different fistula types and to confirm that MMP-9 is a potential target for fistula therapy in CD patients.Immunohistochemistry for total and active MMP-9, Cytokeratin 8 (CK-8) and co-staining of active MMP-9/CK-8 was performed in specimen derived from perianal fistulas, entero-enteric fistulas and fistulas from patients not responding to anti-TNF therapy. In addition, fistulas from the xenograft mouse model (anti-TNF treated or untreated) were analyzed.Total and active MMP-9 protein was detectable in cells lining the tracts of perianal and entero-enteric fistulas. Of note, total and active MMP-9 was also expressed in fistulas of CD patients non-responding to anti-TNF treatment. Interestingly, we detected considerable co-staining of active MMP-9 and CK-8 in particular in cells lining the fistula tract and in transitional cells around the fistulas. Furthermore, total and active MMP-9 are detectable in both anti-TNF treated and untreated xenograft fistulas.Taken together, our data suggest that MMP-9 is involved in fistula pathogenesis in CD patients, in fistulas of different origins and particularly in patients non-responding to anti-TNF therapy. Our xenograft fistula model is suitable for studies investigating a possible therapeutic role for MMP-9 targeting as fistula therapy.
Topics: Animals; Crohn Disease; Heterografts; Humans; Intestinal Fistula; Matrix Metalloproteinase 9; Mice; Tumor Necrosis Factor Inhibitors
PubMed: 34709129
DOI: 10.1080/21688370.2021.1994350 -
Gut Dec 2001
Topics: Humans; Intestinal Fistula
PubMed: 11878788
DOI: 10.1136/gut.49.suppl_4.iv1 -
Hawai'i Journal of Medicine & Public... Jun 2012The cholecystocolonic fistula is an atypical variant of biliary disease. When presenting with symptomatic disease, surgical treatment with cholecystectomy, fistula...
The cholecystocolonic fistula is an atypical variant of biliary disease. When presenting with symptomatic disease, surgical treatment with cholecystectomy, fistula takedown and possible colonic resection are indicated, however the role of surgery in asymptomatic patients, especially those deemed higher risk is less clear. Herein we present a case of an incidentially discovered asymptomatic cholecystocolonic fistula in a higher risk surgical patient managed nonoperatively. The presentation and treatment options for this disease are discussed in relation to their application to this patient.
Topics: Biliary Fistula; Cholecystectomy, Laparoscopic; Colonic Diseases; Diagnosis, Differential; Gallbladder Diseases; Humans; Intestinal Fistula; Male; Middle Aged; Treatment Outcome
PubMed: 22787563
DOI: No ID Found -
Digestive Diseases (Basel, Switzerland) 2010In population-based studies, up to 50% of patients with Crohn's disease suffer from fistulas. Fistulas pose a considerable morbidity including permanent sphincter and... (Review)
Review
In population-based studies, up to 50% of patients with Crohn's disease suffer from fistulas. Fistulas pose a considerable morbidity including permanent sphincter and perineal tissue destruction as well as professional and personal disabilities. Treatment options have progressed in recent years and fistula closure and fibrosis of the fistula track is achieved in some patients. Depending on severity of symptoms and fistula location, different medical and surgical therapies can be chosen. Internal fistulas such as ileoileal or ileocecal fistulas are either asymptomatic and do not require intervention or they are symptomatic and need surgery alone. They always carry a risk of abscess formation. Symptomatic perianal fistulizing disease can be treated with antibiotics (i.e. metronidazole and ciprofloxacin) for three months and/or immunosuppressant therapy (6-mercaptopurine or azathioprine). More complex cases require therapy with anti-TNF agents. Only few and preliminary data exist on cyclosporine A, tacrolimus or methotrexate in fistulizing Crohn's disease. Therefore, these therapies should mainly be used as second-line therapies. Surgery is reserved for the treatment of perianal sepsis in the presence of abscesses and refractory disease or complications of fistulas, or used in combination with pharmacological approaches. The surgical interventions in perianal disease consist of surgical drainage with or without seton placement, transient ileostomy, or in severe cases, proctectomy. The classification of fistulas in patients with Crohn's disease remains poorly defined and largely investigator dependent. The unresolved challenges in fistula treatment warrant randomized controlled trials for existing and future treatment strategies as well as a better classification system to compare available studies.
Topics: Adrenal Cortex Hormones; Aminosalicylic Acids; Crohn Disease; Humans; Intestinal Fistula; Placebos; Tumor Necrosis Factor-alpha
PubMed: 20926886
DOI: 10.1159/000320416 -
The Permanente Journal Sep 2021Cholecystocolonic fistula is a very rare complication of chronic cholecystitis, often diagnosed intraoperatively during interventions for the complications that it could... (Review)
Review
INTRODUCTION
Cholecystocolonic fistula is a very rare complication of chronic cholecystitis, often diagnosed intraoperatively during interventions for the complications that it could cause. Clinical presentation is nonspecific, and no consensus exists on the management of fistula.
METHODS
A case report and literature review of 14 articles published between 2009 and 2020 were included in this study. Most of the articles included were a combination of case report with literature review, and the remainder were solely case reports or literature reviews.
RESULTS
History, physical examination, and radiologic studies have been unsuccessful in the preoperative diagnosis of cholecystocolonic fistula. Treatment choice is balanced on the risks and benefits and is case specific; however, it is always directed toward resolving the urgent complication.
CONCLUSION
Even though cholecystocolonic fistula is a rare condition, it should be considered in elderly patients with a hx of cholelithiasis and diverticulosis presenting with bowel obstruction. This case report was prepared following the CARE Guidelines.
Topics: Aged; Humans; Intestinal Fistula; Intestinal Obstruction
PubMed: 35348090
DOI: 10.7812/TPP/21.014 -
World Journal of Surgery Mar 2018The timing of intestinal failure (IF) surgery has changed. Most specialized centers now recommend postponing reconstructive surgery for enteric fistula and emphasize... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The timing of intestinal failure (IF) surgery has changed. Most specialized centers now recommend postponing reconstructive surgery for enteric fistula and emphasize that abdominal sepsis has to be resolved and the patient's condition improved. Our aim was to study the outcome of postponed surgery, to identify risk factors for recurrence and mortality, and to define more precisely the optimal timing of reconstructive surgery.
METHODS
PubMed, Embase, and the Cochrane Library were systematically reviewed on the outcomes of reconstructive IF surgery (fistula recurrence, mortality, morbidity, hernia recurrence, total closure, enteral autonomy). If appropriate, meta-analyses were performed. Optimal timing was explored, and risk factors for recurrence and mortality were identified.
RESULTS
Fifteen studies were included. The weighted pooled fistula recurrence rate was 19% (95% CI 15-24). Lower recurrence rates were found in studies with a longer median time and/or, at the minimum of the range, a longer time interval to surgery. Overall mortality was 3% (95% CI 2-5). Total fistula closure rates ranged from 80 to 97%. Enteral autonomy after reconstructive surgery, mentioned in four studies, varied between 79 and 100%.
CONCLUSIONS
Postponed IF surgery for enteric fistula is associated with lower recurrence. Due to the wide range of time to definitive surgery within each study, optimal timing of surgery could not be defined from published data.
Topics: Cutaneous Fistula; Digestive System Surgical Procedures; Elective Surgical Procedures; Humans; Intestinal Fistula; Postoperative Complications; Plastic Surgery Procedures; Recurrence; Risk Factors; Time-to-Treatment
PubMed: 28924879
DOI: 10.1007/s00268-017-4224-z -
Acta Medica Portuguesa 2011Duodenocaval fistula is a type of digestive fistula rarely described in the literature. It usually manifests by sepsis associated with gastrointestinal bleeding. The...
Duodenocaval fistula is a type of digestive fistula rarely described in the literature. It usually manifests by sepsis associated with gastrointestinal bleeding. The treatment is surgical and the prognosis usually not favorable. We describe the case of a woman admitted to our hospital with sepsis, having been diagnosed with a duodenocaval fistula secondary to perforation of the digestive tract by a foreign body. Surprisingly, the fistula sealed by itself, without the need of surgery, and with a favorable evolution.
Topics: Duodenal Diseases; Female; Humans; Intestinal Fistula; Intestinal Perforation; Middle Aged; Vascular Fistula; Vena Cava, Inferior
PubMed: 22525640
DOI: No ID Found -
Nutrients Mar 2022Short bowel syndrome (SBS) and enterocutaneous or enteroatmospheric fistulas are common indications for home parenteral nutrition (HPN). However, there are few data...
Short bowel syndrome (SBS) and enterocutaneous or enteroatmospheric fistulas are common indications for home parenteral nutrition (HPN). However, there are few data describing factors influencing surgical decision-making or outcomes particularly following fistula development. We aimed to compare outcomes between patients with SBS and fistulas and explore surgical decision-making. HPN-dependent adults from 2001−2018 at a national reference centre were included in this study. HPN cessation was analysed using death as competing risk. In total, 465 patients (SBS (62%), fistula (38%)) were included, with median HPN dependency of 2.6 years. In total, 203 patients underwent reconstructive surgery; while frailty was the commonest reason for not undergoing surgery (49.2%), 22.7% declined surgery. Overall, 170 ceased HPN, with a probability of 13.8%, 34.1% and 38.3% at 1, 5 and 10 years, respectively. Patients undergoing surgery had higher nutritional autonomy rates (109.8 incidences/1000 patient years) compared to those not undergoing surgery (18.1 incidences/1000 patient years; p < 0.001). A total of 295 patients (63.4%) were predicted to cease HPN based on gastrointestinal anatomy but only 162/295 (54.9%) achieved this; those unable to do so were older with a higher comorbidity index. There were no differences in long-term nutritional and survival outcomes or surgical decisions between patients with SBS and fistulas, or between enterocutaneous and enteroatmospheric fistulas. This study represents one of the largest datasets describing the ability of HPN-dependent patients with SBS or fistulas to achieve nutritional autonomy. While reconstructive surgery facilitates HPN cessation, approximately one-fifth of patients declined surgery despite HPN dependency. These data will better inform patient expectation and help plan alternative therapies.
Topics: Adult; Humans; Intestinal Failure; Intestinal Fistula; Parenteral Nutrition, Home; Probability; Retrospective Studies; Short Bowel Syndrome
PubMed: 35406061
DOI: 10.3390/nu14071449 -
Alternative Therapies in Health and... Jan 2023To analyze the comfort and influencing factors in patients with enterocutaneous intestinal fistula (ECF) on hospital admission and propose targeted nursing intervention...
OBJECTIVE
To analyze the comfort and influencing factors in patients with enterocutaneous intestinal fistula (ECF) on hospital admission and propose targeted nursing intervention countermeasures.
METHODS
A total of 193 patients with EDF admitted to Hunan Provincial People's Hospital in China from May 2018 to February 2021 were selected for this study. Basic patient data were collected upon admission and the Kolcaba Comfort Scale was used to score comfort status. Univariate and multivariate analysis methods were used to analyze the influencing factors.
RESULTS
Patients with ECF have low comfort scores; the social, psychological, physiological and environmental dimensions were affected by 8, 7, 4 and 2 factors, respectively. The number of fistulas and skin condition in patients with ECF were the main physiological factors affecting patients.
CONCLUSION
Paying attention to the fistula and surrounding skin care and strengthening psychological counseling can improve the comfort of patients with ECF.
Topics: Humans; Intestinal Fistula; China
PubMed: 36074964
DOI: No ID Found