Gastrointestinal Fistulae

Abstract

Fistulas are abnormal communications between two epithelialized surfaces. An intestinal fistula is an abnormal anatomic connection between a part (or multiple parts) of the intestinal lumen and the lumen of another epithelialized structure or the skin. Gastrointestinal may be classified based on anatomic, physiologic, or etiologic criteria. Most fistulas occur following abdominal surgeries and only 15-25% of spontaneous. Gastrointestinal fistulae are associated with significant morbidity and mortality. Patients with Gastrointestinal fistulae are faced with the burden of overcoming septic complications resulting from early intra-abdominal infection, fluid electrolyte imbalance and malnutrition. The clinical presentation of the various forms of intestinal fistulas depends on the organs involved. Initial evaluation of an ECF begins with clinical suspicion followed by radiographic studies to define the anatomy of the fistula. Contrast studies in the form fistulograms best define the tract whereas cross-sectional Summary and Conclusion 86 imaging is useful for identifying potential managementaltering factors such as abscesses and obstructions. Other modalities such as small bowel follow-through, CT enterography, MR enterography, and endoscopy. Once an ECF is diagnosed, the first step is to resuscitate and treat sepsis. The second is to control fistula output. The third step is to optimize the patient medically and nutritionally. The last step, when necessary, is definitive restoration of gastrointestinal continuity, after extensive preoperative planning and The key to successful operative intervention is patience. Several methods of nonsurgical fistula closure have been attempted like fibrin glue therapy, gelfoam embolization, the over the scope clip, myocutaneous flap cover and electrical nerve stimulation