2. • Fistulas are abnormal communications between
two epithelial-lined surfaces
• Gastrointestinal (GI) fistulas represent abnormal
ductlike communications between the gut and
another epithelial-lined surface
– organ system
– skin surface
– GI tract itself
3.
4. • The majority of external (cutaneous)
fistulas represent a complication of recent
abdominal surgery
• The leading causes of internal fistulas
– Crohn disease
– Diverticulitis
– Malignancy
– Complication of treatment
5. • F – Foreign Body
• R – Radiation
• I – IBD / Infection
• E – Epithelialized tract
• N – Neoplasm
• D – Distal Obstruction
• S – Segment (>2cm)
6. • High output fistula are from upper GI tract
• High-output GI fistula discharge more than
500ml/day
• High-output pancreatic fistula is one which
produces more than 200 ml/day
• High output fistula
– more serious metabolic disturbances
– higher mortality rates
7. • Spontaneous closure
– bowel continuity is maintained
– no abscess
– adjacent bowel is healthy
– no distal obstruction
– fistula tract is not epithelialized
– not more than 2 cm in length
– bowel defect is less than 1 cm in diameter
• Least likely to close with non-operative therapy
– gastric
– lateral duodenal
– ligament of Treitz
– ileal fistula
8. • Nutritional Support
– Minerals, vitamins, electrolytes
– Caloric intake (35-45 cal/kg/day)
– Protein (1.5-1.75 gm/kg/day)
– TPN
9. • Recognition and Stabilization
– fluid resuscitation, electrolytes, acid/base balance,
control of sepsis, local wound care, nutritional support
• Investigation and Assessment
– radiological
– source, nature of tract, bowel continuity, obstruction,
adjacent bowel, abscess
• Definitive Treatment
– somatostatin and nutritional support, surgical
resection +/- diversion
