Enterocutaneous Fistulas
 
Fistulas are abnormal tunnels either between organs or between an organ and the skin.  Some fistulas may develop as a result of disease such as Crohn’s disease or diverticulitis.  Other fistulas, such as rectovaginal fistulas, may result from traumatic events that can occur in childbirth and in surgery when an incidental injury to the intestine has occurred.  Injury to the intestine during surgery is not always preventable. 
 
In diseases like abscess formation or during previous surgery the bowel can become so firmly adhered to its surroundings that the usual maneuvers to gain access to the abdomen can lead to unavoidable injury to the intestine. As a general rule the fistulas in these cases develop a week after surgery with stool draining through the surgical incision.  As one would expect patients are extremely anxious when this kind of fistula occurs and the surgeon is just as anxious to alleviate the concern.  
 
While one of the common reactions to relieve the problem is to take the patient back to the operating room, this path is usually not advisable because it can create even worse problems including more fistulas and the loss of additional intestine.
 
Therefore, the most common way to handle an enterocutaneous fistula is to eradicate any infectious focus, protect the skin and abdominal wall with a good collecting system and give rest to the intestine with intravenous nutrition for a period of 8 to 12 weeks.  Only then are the tissues suitable for safe dissection and repair with less risk of losing significant lengths of intestine.  We often require studies such as fistulograms, CT scans and endoscopies to determine the best way to manage fistulas.

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