Classification Types Of Postoperative Enterocutaneous Fistula As A Determinant Of Outcome Of Treatment In Ile-Ife, Nigeria

Abstract

Objective: Post operative enterocutaneous fistula, in this environment, continues to excite interest because it runs a distressing course, and it is often associated with high mortality and morbidity. Determining the classification type best suited to suggest the outcome would be helpful in guiding the management of the condition.
Setting: Ife Hospital Unit, Obafemi Awolowo Teaching Hospitals Complex, Ile – Ife.
Outcome Measure: To determine the clinical pattern of post operative external enterocutaneous fistula and the classification method that best predict outcome of the condition.
Methodology: Consecutive patients with clinical postoperative external enterocutaneous fistula seen between 1994 and 2006 were studied. The case files were retrieved and information on demographic data, type of initial surgery, source of referral, and characteristic of the fistula in terms of effluent per day and type of intestine involved were retrieved and analyzed. Patient with incomplete clinical information were excluded from the study.
Result: There were 30 patients aged 17 to 65 years, mean of 33 years ±SD 12.23 years, with male to female ratio of 2:1. Length of hospital stay ranged from 1 to 43 weeks. Majority 28 (93.3%) were referred after primary operation at the lower cadre hospitals.
Enterocutaneous fistula followed intestinal resection in 15 cases (50.0%) and was post appendicectomy in 9 cases (30.06%). Three (11.1%) cases each had burst abdomen and Acquired Immunodeficiency Syndrome (AIDS) in 3 cases (11.1%) additionally. Overall mortality was 12 (40 %) was high. Compared with the other classifications considered in the study classification into high and low output highly correlated with the outcome of treatment logistic regression p < 0.006 versus p = 0.123 and p = 0.244 respectively for Sitges – Serra and schein and groups.
Conclusion: In this study majority of patients with enterocutaneous fistula were referred from Private and State hospitals set up. This might be a reflection of the generally lower level of technical surgical skills at this level of healthcare facilities. Classification of enterocutaneous fistula into high and low output was still useful in our environment for predicting prognosis and may, therefore, be used to guide management strategies.


Keywords: Post operative enterocutaneous fistula, Treatment outcome determinant, Classification.

Sahel Medical Journal Vol. 11 (4) 2008: pp. 105-109