Early operative treatment for an enterocutaneous fistula after gunshot wound

Abstract

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.