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Clin Colon Rectal Surg 2010; 23(3): 182-189
DOI: 10.1055/s-0030-1262986
Published by Thieme Medical Publishers

Enterocutaneous Fistulas in the Setting of Trauma and Critical Illness

Joseph J. Dubose1 , Jonathan B. Lundy2
  • 1R. Adams Cowley Shock Trauma Center, University of Maryland Medical System, Air Force Center for Sustainment of Trauma Readiness Skills, Baltimore, Maryland
  • 2United States Army Institute of Surgical Research, Fort Sam Houston, Texas
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Publication History

Publication Date:
24 August 2010 (online)

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ABSTRACT

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 EAF/ECF, and techniques for prevention of these dreaded complications in patients with an open abdomen.

KEYWORDS

Enterocutaneous and enteroatmospheric fistula - trauma - open abdomen - temporary abdominal closure

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Jonathan B LundyM.D. 

United States Army Institute of Surgical Research

3400 Rawley E. Chambers, Fort Sam Houston, TX 78234

Email: jlundy1313@yahoo.com

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