Early operative treatment for an enterocutaneous fistula after gunshot wound

A Dogjani, B Hasanaj, E Matevossian, D Doll, R Latifi


Background: The successful  treatment  of an enterocutaneous fistula (ECF) is challenging  even for experienced surgeons,  as it is associated  with potential  complications  such  as infection,  abdominal  sepsis,  fluid-electrolyte disturbances, septic shock and malnutrition. All of these conditions may congregate and lead to increased mortality in these patients, additional to the original trauma.

Case Report: We describe a 27-year old male who was shot once in the left thoraco-abdominal region without an exit wound. On laparotomy, multiple injuries to jejunum, ileum and sigmoid were identified. Primary repair of sigmoid was done as well as end-to-end jejunostomy and end-to-end ileostomy. At postoperative day 10, an ECF erupted as a low output fistula (100ml/24h).  The patient was put on full parenteral treatment. Following work up including  CT scan and fistulogram,  the patient was taken back to the operating  room for washout and diverting ileostomy with fistula tract resection. He fully recovered uneventfully following this second operation.

Conclusion: As shown in this patient without malnutrition and penetrating injury, early surgical treatment may work out advantageously  and swift, compared to possible conservative  treatment in this low output fistula following a gunshot of the thoraco- abdominal region. 

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Edmunds LH Jr, Williams GM, Weleh CF. External fistulae arising from gastro-intestinal tract. Ann Surg 1960;152:445–71.

Hollington P, Mawdsley J, Lim W, Gabe SM, Forbes A,Windsor AJ. An 11-year experience of entero- cutaneous fistula. BJS 2004;91:1646–51.

West MA. Conservative and operative management of gastrointestinal fistulae in critically ill patients. Curr Opin Crit Care 2000;6:143–47.

Martinez JL, Luque-de-Leon E, Mier J, Blanko Benavides, Robledo F. Systematic management of post-operative enterocutaneous fistulae: Factors related to outcome. World J Surg 2008;32:436–43.

Evenson AR, Fischer JE. Current management of enterocutaneous fistula. J Gastrointestinal Surg 2006;10:445–6.

Berry SM, Fischer Reclassification and pathophysiology of entero-cutaneous fistulae. Surg Clin North Am 1996;76:1009–18.

MacFadyen BV Jr, Dudrick SJ, Ruberg RL. Management of gastrointestinal fistulas with parenteral hyperalimentation. Surgery 1973;74(1):100–105

Chapman R, Foran R, Dunphy JE. Management of intestinal fistulas. Am J Surg 1964;108:157–164

Both figures adapted from Rolstad BS, Bryant R. Management of drain sites and fistulas. In Bryant R (ed.), Acute and Chronic Wounds. St. Louis: Mosby. 2000:318.

Adapted from Rolstad BS, Bryant R. Management of drain sites and fistulas. In Bryant R (ed.), Acute and Chronic Wounds. St. Louis: Mosby. 2000:317–341.

Kozell K, Martins L. Fistula Management: A Multidisciplinary Approach. Paper presented at the General Surgery Conference, London, Ontario. 2001.

Lynch AC, Delaney CP, Senagore AJ, Connor JT, Remzi FH, Fazio VW. Clinical outcome and factors predictive of recurrence after entero-cutaneous fistula surgery. Ann Surg 2004;240:825–31.

Schein M, Decker G. Gastro-intestinal fistula associated with large abdominal defects: experience with 43 patients.Br J Surg 1990;77:97–100.

Schein M, Decker GA. Post-operative external alimentary tract fistulae. Am J Surg 1999;161:435–8.

Blackett RL, Hill GL. Post-operative external small bowel fistulae: A study of a consecutive series of patients treated with intravenous hyperalimentation. Br J Surg 978;65:775–8.

Joseph EG. High intestinal fistula and its treatment by the use of a Pauls tube. Am J Surg 1948;75(4):640–642

Mayo CH. Enterostomy and the use of the omentum in the prevention and healing of fistula. Ann Surg 1917;66(5):568–570, 1

Li J, Ren J, Zhu W, Yin L, Han J. Management of enterocutaneous fistulae: 30-year clinical experience. Chin Med J (Engl) 2003;116(2):171–5.

Galie KL, Whitlow CB. Post-operative entero-cutaneous fistula: When to re-operate and how to succeed. Clin Colon Rectal Surg 2006;19(4):237–43.


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