Gastro-Intestinal Fistula

Hashmi

• Fistulas are abnormal communications between two epithelial-lined surfaces

• Gastrointestinal (GI) fistulas represent abnormal ductlike communications between the gut and another epithelial-lined surface– organ system– skin surface

– GI tract itself

http://radiology.rsnajnls.org/content/vol224/issue1/images/large/r02jl23l1x.jpeg

• The majority of external (cutaneous) fistulas represent a complication of recent abdominal surgery

• The leading causes of internal fistulas– Crohn disease– Diverticulitis– Malignancy– Complication of treatment

• F – Foreign Body• R – Radiation• I – IBD / Infection• E – Epithelialized tract• N – Neoplasm

• D – Distal Obstruction• S – Segment (>2cm)

• High output fistula are from upper GI tract

• High-output GI fistula discharge more than 500ml/day

• High-output pancreatic fistula is one which produces more than 200 ml/day

• High output fistula– more serious metabolic disturbances– higher mortality rates

• Spontaneous closure– bowel continuity is maintained– no abscess– adjacent bowel is healthy– no distal obstruction– fistula tract is not epithelialized– not more than 2 cm in length– bowel defect is less than 1 cm in diameter

• Least likely to close with non-operative therapy– gastric– lateral duodenal– ligament of Treitz– ileal fistula

• Nutritional Support– Minerals, vitamins, electrolytes

– Caloric intake (35-45 cal/kg/day)– Protein (1.5-1.75 gm/kg/day)– TPN

• Recognition and Stabilization– fluid resuscitation, electrolytes, acid/base balance,

control of sepsis, local wound care, nutritional support

• Investigation and Assessment– radiological– source, nature of tract, bowel continuity, obstruction,

adjacent bowel, abscess

• Definitive Treatment– somatostatin and nutritional support, surgical

resection +/- diversion