Experience with enterocutaneous fistula management in a district hospital in Nigeria

Abstract

Background: Enterocutaneous fistula (ECF) is an abnormal communication between gastrointestinal tract and skin. It is a difficult condition to treat and morbidity and mortality remain high in many centers. Malnutrition and sepsis are the leading causes of death. There are no clear guidelines for optimal nutritional management. Aggressive measures to maintain positive nitrogen balance is the ultimate goal of nutritional management. Our objective was to review the practice of the nutritional management and outcome of ECF in a resource limited setting in Nigeria.

Methods: A retrospective study of all patients with ECF managed between 2006 and 2015. Management included resuscitation, control of sepsis, enteral feeding, skin care and timely surgical intervention.

Results: A total of 57 patients were managed. Aetiology of ECF in this study was post-operative in 96.5% of cases. Fistula closure was achieved in 51/57 patients (89.5%). Thirty-nine (68.42%) fistulae closed spontaneously on conservative management while 12 (21.05%) fistulae healed following restorative surgery. Mortality rate was 10.5%. Rate of healing was related to serum albumin level and fistula output.

Conclusion: Aggressive enteral feeding allows a favorable outcome in enterocutaneous fistula after a convalescence period. High output and hypoalbuminaemia were important prognostic variables.

Keywords: Enterocutaneous fistula,enteral feeding, outcome, resource-limited setting