An enterocutaneous fistula (ECF) is an abnormal communication between the

small Small may refer to: Science and technology * SMALL, an ALGOL-like programming language * Small (anatomy), the lumbar region of the back * ''Small'' (journal), a nano-science publication * <small>, an HTML element that defines smaller text ...

large bowel The large intestine, also known as the large bowel, is the last part of the gastrointestinal tract and of the digestive system in tetrapods. Water is absorbed here and the remaining waste material is stored in the rectum as feces before being ...

and the skin that allows the contents of the stomach or intestines to leak through an opening in the skin.

Causes

The mnemonic 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 A foreign body (FB) is any object originating outside the body of an organism. In machinery, it can mean any unwanted intruding object. Most references to foreign bodies involve propulsion through natural orifices into hollow organs. Foreign bo ...

* R

Radiation In physics, radiation is the emission or transmission of energy in the form of waves or particles through space or through a material medium. This includes: * ''electromagnetic radiation'', such as radio waves, microwaves, infrared, visi ...

* I Infection or

Inflammatory bowel disease Inflammatory bowel disease (IBD) is a group of inflammation, inflammatory conditions of the colon (anatomy), colon and small intestine, Crohn's disease and ulcerative colitis being the principal types. Crohn's disease affects the small intestine a ...

* E Epithelialization * N Neoplasm * 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 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 Somatostatin, also known as growth hormone-inhibiting hormone (GHIH) or by several other names, is a peptide hormone that regulates the endocrine system and affects neurotransmission and cell proliferation via interaction with G protein-couple ...

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