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Phases of management for enterocutaneous fistulae
Phases of management for enterocutaneous fistulae
Phase
Description
Timing
Stabilization
Rehydration
Correction of anemia
Electrolyte repletion
Drainage of sepsis
Control of fistula drainage
Local skin care measures
Commencement of nutritional support
24-48 h
Investigation
Fistulogram to define anatomy
CT/US/MRI to localize collections and guide drainage
7-10 d
Decision
Assess likelihood of nonoperative closure
Plan therapeutic course
Decide optimal surgical timing
7-10 d to 4-6 wk
Definitive therapy
Plan operative approach
Bowel resection with end-to-end anastomosis
Secure abdominal closure (+/- flap)
Gastrostomy
Jejunostomy
4-6 wk or if spontaneous closure unlikely
Healing
Continue nutrition support
Transition to total oral/enteral feedings
Physical and emotional rehabilitation
5-10 d after closure
Phases_of_management_for_enterocutaneous_fistulae.htm
CT: computed tomography; US: ultrasound; MRI: magnetic resonance imaging.
Reproduced with permission from: Fischer JE, Evenson AR. Gastrointestinal-cutaneous fistulae. In: Mastery of Surgery, Fischer JE (Ed), Lippincott Williams & Wilkins 2007. Copyright © 2007 Lippincott Williams & Wilkins.
www.lww.com
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