Abstract

An enterocutaneous (EC) fistula is referred to as a channel between the gut and the skin. Effluent of an EC fistula of more than 500 ml per day is considered as high output. Patients with high output EC fistulae have a high morbidity and mortality rate. No evidence-based guidelines are available for this condition and more research is required to evaluate the effectiveness of treatment. Nevertheless, patients with fistulae should be managed based on the available evidence, detailed clinical and nutrition assessment, and close monitoring. Management of high output EC fistula is complex and challenging. It involves nutrition, medical, skin care and psychological treatment, which is best managed by a multidisciplinary team. It requires an individualized nutrition and clinical treatment plan to maximize patient outcomes. Up to 70% of patients with fistulae have malnutrition and it is a significant prognostic factor of spontaneous fistula closure. Nutrition therapies including macronutrient and micronutrient delivery, enteral nutrition and parenteral nutrition are discussed in this review. A case study of a patient with multiple EC fistulae is presented to illustrate the management of high output EC fistulae.

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Authors

Tong CY, Lim LL, Brody RA

Institution

National University Hospital, Dietetics Department, Singapore. cherie_tong@nuhs.edu.sg

Source

Asia Pacific journal of clinical nutrition 21:3 2012 pg 464-9

MeSH

Adult
Anti-Bacterial Agents
Female
Humans
Intestinal Fistula
Intraabdominal Infections
Parenteral Nutrition
Postoperative Complications
Sepsis
Severity of Illness Index
Treatment Outcome
Young Adult

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

22705439