Enterocutaneous Fistulas in the Setting of Trauma and Critical Illness
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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One of the most devastating complications to develop in the general surgical patient is an enterocutaneous fistula ECF. Critically ill patients suffering trauma, thermal injury, infected necrotizing pancreatitis, and other acute intraabdominal pathology are at unique risk for this complication as well. By using decompressive laparotomy for abdominal compartment syndrome and leaving the abdomen open temporarily for other acute processes, survival in some instances may be improved. However, the exposed viscera are at risk for fistulization in the presence of an open abdomen, a newly defined entity termed the enteroatmospheric fistula EAF. The purpose of this article is to describe the epidemiology of ECF in the setting of trauma and critical illness, nutrition in injured critically ill patients with ECF, pharmacologic adjuncts to decrease fistula effluent, wound care, surgical management of the EAFECF, and techniques for prevention of these dreaded complications in patients with an open abdomen.
- Medicine and Medical Research