What is an Enterocutaneous Fistula?

An enterocutaneous fistula is an abnormal connection between the large or small bowels and the skin, and it allows the contents of the intestinal tract to leak out of the body through a gash, opening or wound. The condition occurs because of surgical procedures, traumatic injuries or diseases. Enterocutaneous fistulas are difficult to treat and have a high mortality rate.

The condition can occur for various reasons. An enterocutaneous fistula might occur after a surgical operation. Patients who receive cancer therapy in the form of abdominal radiation are at risk of developing an enterocutaneous fistula. Individuals who have inflammatory bowel conditions and people who have received wounds to the abdomen through traumatic injury, such as a stab wound or gunshot wound, also are at risk.

A patient who has an enterocutaneous fistula might have high levels of white blood cells, fever, tenderness in the abdominal area and evident drainage of intestinal matter from the wound. Some patients become dehydrated or malnourished. Others develop infections at the injury site.

Sepsis, which is a disease caused by bacteria in the bloodstream, is a serious complication of enterocutaneous fistula. The major organs in the body shut down, and the body goes into shock from low blood pressure levels. Sepsis can lead to death.

A doctor can diagnose an enterocutaneous fistula by examining the patient's physical symptoms. He or she might also conduct additional tests to find out exactly where the fistula has occurred. Several of these tests include gastrointestinal contrast studies, computed tomography (CT) scans and ultrasounds.

Medical practitioners address the condition by draining the abscessed wound and by giving the patient nutrients and liquids to combat nutritional imbalances and malnutrition. They might also prescribe antibiotic medication to control infections. Fistulas that do not respond to therapy within four to six weeks require more drastic treatment methods.

Surgeons might operate on the fistula to close it up if necessary, particularly if the wound appears to be growing more infected or is developing gangrene. They might need to remove part of the intestinal tract as well as the fistula to get the infection under control if the wound fails to heal. Doctors also can close enterocutaneous fistulas using fibrin glue, which is a biological adhesive.

The prognosis for recovery varies depending on the patient. The mortality rate typically is 5-20 percent. Most patients who succumb to complications from enterocutaneous fistulas usually lose their lives because of the loss of fluids or electrolytes, sepsis infections and malnutrition. People who were generally healthy before developing a fistula have an excellent chance of making a full recovery.