(Gastrointestinal Fistula; Entero-enternal Fistula)
DefinitionAn enterocutaneous fistula is an abnormal connection between the intestines and the skin. Intestinal or stomach contents can leak through this connection. The contents may leak into another part of the body or outside of the body.
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CausesMost enterocutaneous fistulas develop as a complication of bowel surgery. Other causes include:
- Bowel disease, such as Crohn’s disease or ulcerative colitis
- Perforated duodenal ulcers
- Trauma, such as a gunshot or stabbing
- Complications of cancer treatment, such as radiation therapy
Risk FactorsFactors that may increase your chance of enterocutaneous fistula include:
- History of radiation
- Poor nutrition
SymptomsSymptoms may include:
- Leakage of intestinal contents from an abdominal wound onto the skin
- Abdominal pain
- Signs of infection, such as fever, chills, and rapid heart rate
DiagnosisYou will be asked about your symptoms and medical history. A physical exam will be done. You may be referred to a colon and rectal surgeon.Images may be taken of your bodily structures. This can be done with:
TreatmentA fistula may be able to heal on its own over 2-8 weeks. Talk with your doctor about the best treatment plan for you. Treatment options include the following:
- Nutritional support may be needed while the fistula is healing:
- You may need to drink and eat high energy food for a while.
- Nutrition may need to be delivered through a tube connected to your stomach or intestine.
- If your bowels need to rest, nutrition may be given through your vein.
- Antibiotics may be prescribed to help prevent or control infection.
- A drain may be attached to your wound to collect leakage from the fistula.
- If the fistulas do not heal, then part of the intestine may need to be removed.
PreventionThere are no steps you can take to help prevent fistulas.
American Gastroenterological Association
Crohn’s and Colitis Foundation of America
Crohn's and Colitis Canada
Cobb A, Knaggs E. The nursing management of enterocutaneous fistulae: a challenge for all. BrJCommunity Nurs. 2003;8;9:S32-8.
Enterocutaneous fistula. UCSF Medical Center website. Available at: http://www.ucsfhealth.org/conditions/enterocutaneous%5Ffistula. Accessed April 2, 2013.
Pritts TA, Fischer DR, Fischer JE. Postoperative enterocutaneous fistula. Holzheimer RG, Mannick JA, editors. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt; 2001. Available from: http://www.ncbi.nlm.nih.gov/books/NBK6914. Accessed September 23, 2014.
- Reviewer: Daus Mahnke, MD
- Review Date: 08/2014
- Update Date: 09/23/2014
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