Enterocutaneous fistula. Causes and management

OBJECTIVE: To study the main causes of fistula, and to determine the factors related to a successful treatment. METHODS: From November 2002 to October 2005, a total of 70 consecutive patients with enterocutaneous fistula in Gastroenterology and Hepatology Teaching Hospital, Baghdad, Iraq, were studied prospectively. Fifty-two patients received total parenteral nutrition. Internal gastrointestinal fistula, and pure pancreatic and biliary fistula were excluded from this study. RESULTS: In 68 patients, the fistula developed postoperatively, the most common primary cause was missile injury (42%), and 2 patients have fistula that developed spontaneously. The fistula was healed by conservative treatment in 34 patients, and by surgical intervention in 10. Twenty-five patients died, and in one patient the fistula failed to heal by conservative as well as by surgical treatment. The mean duration of hospital stay for all patients was 25.9 days. CONCLUSION: The most common cause of enterocutaneous fistula found in this study was missile injury. Duodenal fistula and, to a lesser extent, ileal fistula, respond more to conservative treatment. High output and jejunal fistula were associated with poorer outcome. Octreotide administration did not significantly improve the output of the fistula or the outcomes.