Table 1 Fundamentals of the current multispecialist approach to enterocutaneous fistula management
From: Enterocutaneous fistulas: a primer for radiologists with emphasis on CT and MRI
Step no. | Treatment basics | Comments |
|---|---|---|
1 | Control of sepsis | Often requiring intensive care support Imaging-guided drainage of abscess collections |
2 | Limiting output volume | Octreotide administration Bowel rest, enteral, or parenteral nutrition |
3 | Wound or skin care | Use of dressings or bags depending on output Suction or Vacuum-Assisted Closure (VAC) devices if available |
4 | Metabolic and nutritional optimisation | Adequate hydration, electrolytes balance, nutritional status Proximal versus location in the bowel influences nutritional and fluid requirements |
5 | Assessing likelihood of spontaneous closure | Versus percutaneous treatment or elective surgical repair Factors associated with favourable healing: - narrow-calibre and/or relatively long (>2 cm) ECFs, - small enteric defect or anastomotic dehiscence (<1 cm) Factors associated with probable non-healing: - presence of foreign bodies, - history of irradiation, - active infection, - untreated chronic inflammatory bowel disease, - untreated tumours, - distal obstruction |