Gastro-Intestinal Fistula

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Gastro-Intestinal Fistula

• Hashmi

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• 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

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• 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

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• F Foreign Body
• R Radiation
• I IBD / Infection
• E Epithelialized tract
• N Neoplasm
• D Distal Obstruction
• S Segment (gt2cm)

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• 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

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• 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

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• Nutritional Support
• Minerals, vitamins, electrolytes
• Caloric intake (35-45 cal/kg/day)
• Protein (1.5-1.75 gm/kg/day)
• TPN

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• 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