Enterocutaneous Fistulas

Abstract

Fistulas are abnormal communications between two epithelialized surfaces. The causes of enterocutaneous fistulas can be remembered using the mnemonic FRIEND: Foreign body, Radiation, Inflammation/Infection/Inflammatory bowel disease, Epithelialization, Neoplasm, and Distal obstruction. Fifteen to twenty-five percent of enterocutaneous fistulas arise spontaneously as in, for example, Crohn’s disease or cancer. The remainder occur postoperatively after surgery for diverticulitis or appendicitis; postoperative fistulas can also occur after surgery for inflammatory bowel disease or complications of radiation therapy or if an extensive lysis of adhesions was performed. Some principles may reduce the risk of fistula formation such as: use of healthy, non-inflamed bowel for the anastomosis, adequate mechanical bowel preparation, preoperative antibiotics both intravenously and orally, a tension free anastomosis, adequate hemostasis, and maximizing the patient’s nutritional status prior to surgery.