An enterocutaneous fistula (ECF) is an abnormal communication between the small or large bowel and the skin that allows the contents of the

stomach The stomach is a muscular, hollow organ in the gastrointestinal tract of humans and many other animals, including several invertebrates. The stomach has a dilated structure and functions as a vital organ in the digestive system. The stomach i ...

or intestines to leak through an opening in the skin.

Causes

The

mnemonic A mnemonic ( ) device, or memory device, is any learning technique that aids information retention or retrieval (remembering) in the human memory for better understanding. Mnemonics make use of elaborative encoding, retrieval cues, and imag ...

HIS FRIENDS can be used to memorize characteristics which impede the closure of ECF. H: high output I: IBD S:short tract * F Foreign body * R Radiation * I

Infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

or Inflammatory bowel disease * E

Epithelialization Wound healing refers to a living organism's replacement of destroyed or damaged tissue by newly produced tissue. In undamaged skin, the epidermis (surface, epithelial layer) and dermis (deeper, connective layer) form a protective barrier agains ...

* N

Neoplasm A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

* D Distal obstruction * S Short tract (<2 cm)

Diagnosis

Classification

Congenital types: tracheoesophageal, vitellointestinal duct, patent urachus, rectovaginal Acquired: trauma (postoperative), radiation, malignancy, infection

Two categories

Low-output fistula: < 500 mL/day High-output fistula: > 500 mL/day

Three categories

Low-output fistula: < 200 mL/day Moderate-output fistula: 200–500 mL/day High-output fistula: > 500 mL/day

Treatment

The majority will close spontaneously within approximately 6 weeks. If it has not closed by 12 weeks, it is unlikely to do so and definitive surgery should be planned. The median time to definitive repair from

fistula A fistula (plural: fistulas or fistulae ; from Latin ''fistula'', "tube, pipe") in anatomy is an abnormal connection between two hollow spaces (technically, two epithelialized surfaces), such as blood vessels, intestines, or other hollow or ...

onset was 6 months (range 1 day to 28 months). The 6-month time course is commonly utilized by groups with significant experience treating fistulas, owing to the trend in encountering a less hostile abdomen than in the early phases. Some evidence also suggests that somatostatin can be an effective treatment with respect to reducing closure time and improving the spontaneous closure rate of enterocutaneous fistulas.

References

* {{cite journal , author = Metcalf C , year = 1999 , title = Enterocutaneous fistulae , journal = Journal of Wound Care , volume = 8 , issue = 3, pages = 141–142 , doi=10.12968/jowc.1999.8.3.25854 Digestive diseases Fistulas Medical mnemonics