Factors influencing the outcome of treatment of small bowel cutaneous fistula

摘要: A 20-year review of 174 external fistulas the jejunum and ileum led to identification factors affecting morbidity mortality. The mortality rate for jejunal was higher as compared ileal fistulas, whether treated by nonoperative means (41.7% 29.4%, respectively), conservative surgical (70% 21%, respectively) or radical, i.e., resectional techniques (21.7% 12.2%, respectively). Overall in series 22.4% (39 patients). Respective rates high-output (greater than 200 ml/day) low-output were 30.3% 4.8%; where presence absence significant intra-abdominal sepsis could be clearly established on chart review, 29.6% 0%, respectively. anemia, hypoalbuminemia, malnutrition adversely affected outcome, with 30.7%, 41.9%, 31.8%, outcome when these features absent (8.2%, 3.0%, Etiological also examined. High observed arising due radiation effect (45.4%), gangrenous intestine evisceration (52.4%), those secondary surgery ulcerative colitis (33.3%). Timing fistula had little impact cure, but survival highest such deferred beyond 6 weeks from onset. Improvement has been noted since 1970. While many influence rates, inadequately assumes primary importance. In favorable circumstances, intestinal resection anastomosis is procedure choice. However, staging procedures fistula-bearing segment without enterostomy wide drainage associated should considered local conditions abdomen indicate a likelihood anastomotic breakdown. These invariably improve adequate prevention further contamination; total parenteral nutrition provided mechanism sustaining patient while this improvement occurs, allowing elective reconstruction.