Aetiology, management and outcome of entero-cutaneous fistula in Maiduguri, Nigeria

Abstract

Background: Enterocutaneous fistula (ECF) remains an important surgical problem with significant morbidity and mortality. This study aims to review the aetiology and management outcome in a depressed economy like ours.

Methods: A retrospective review of 54 patients with ECF admitted into the surgical wards of the University of Maiduguri Teaching Hospital (UMTH) between January 1994 and December 2004 (11 year period ).

Results: Thirty two (59.3%) were males and 22 (40.7 %) were females giving a male/female ratio of 1.5 to 1. The age ranged from 1 to 58 years with two peak incidents of 20-29 years and 40-49 years. Eighteen cases (33% ) occurred following appendicectomy, 12 (22% ) following laparotomy for intestinal obstruction, 10 (18.5% ) following laparotomy for abdominal malignancies, 7 (13% ) followed laparotomy for penetrating abdominal injuries, 3 (5.5% ) followed laparotomy for perforated typhoid enteritis, 2 (3.7 %)cases were due to spontaneous rupture of strangulated and neglected inguinal hernia, 1 (1.9% )case followed chest tube insertion for pleural effusion in a PTB patient and 1 (1.9% ) case followed a native healer's incision on a lumber hernia. Altogether,45 (83.3%) were referred cases from peripheral hospitals.Fourty one (76%) were high output type, while 13 (24%) were low output type. . Most patients 32 (59.3%) healed spontaneously on conservative management. Eighteen (33% ) had surgical intervention . Eight patients demised giving a mortality rate of 15%. The average hospital stay was 56 days.

Conclusion: The main cause of ECF in our environment is postoperative (94.4%) with post appendicectomy cases alone accounting for 33%. Majority of our patients (66.7%) were managed conservatively.

Keywords: Enterocutenous fistulae; aetiology; management; outcome; Maiduguri

Nigerian Journal of Clinical Practice Vol.10 (1) 2007: pp.47-51