Enterocutaneous fistulas: effect of nutritional management and surgery

Records of 38 consecutive patients affected by enterocutaneous fistulas were reviewed concerning etiology, site, management, results and prognostic factors. Thirtyfive fistulas resulted from surgical complications, 2 from Crohn's disease and one from pancreatic blunt trauma. Thirty (78.9%) out of 38 fistulas were treated successfully: 22 (57.8%) healed after nutritional treatment, 8 (21.3%) required definitive surgical repair. A significant difference (p = 0.007) in the incidence of medical closure was observed between upper gastrointestinal tract and small bowel fistulas (73.1%) and those located in the large bowel (25%). Large bowel fistulas required definitive surgical repair in 53.8% of cases. Eight patients died prior to fistula resolution; sepsis constituted the major cause of death. Results suggest that the treatment of enterocutaneous fistulas should include early control of infections and appropriate nutritional support. An earlier surgical approach for patients with large bowel fistulas is suggested.