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2003, Número 2

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Gac Med Mex 2003; 139 (2)


Fístulas enterocutáneas postoperatorias

Martínez-Ordaz JL, Luque-de-León E, Suárez-Moreno RM, Blanco-Benavides R

Idioma: Español
Referencias bibliográficas: 57
Paginas:
Archivo PDF: 80.59 Kb.


RESUMEN

Las fístulas enterocutaneas son un problema mayor en la práctica quirúrgica. En general son secundarias a complicaciones postoperatorias. Hasta el 90% de los casos se desarrollan después de una cirugía. La morbilidad y la mortalidad continúan muy elevadas a pesar de los avances en el manejo de esta patología. Las tres complicaciones principales de los pacientes con fístulas son desequilibrio hidroelectrolítico, desnutrición y sepsis, las cuales están en relación con la localización de la fístula, el gasto, las características bioquímicas y electrolíticas de la descarga y la condición patológica subyacente. El objetivo final en el manejo de los pacientes con fístulas es el cierre de la misma. En 1964, Chapman propuso un plan de tratamiento de los pacientes con base en cuatro prioridades. El propósito del tratamiento médico es el cierre espontáneo de la fístula o la preparación del paciente para cirugía. La instalación de un apoyo nutricional adecuado juega un papel esencial para el éxito del tratamiento. El control de la sepsis es una prioridad, la sepsis descontrolada debe ser atacada rápidamente ya que es la principal causa de muerte. El cierre espontáneo ha aumentado en los últimos años; sin embargo, es probable que todavía una gran parte de los pacientes ameriten tratamiento quirúrgico, y éste debe ser realizado en el momento adecuado.


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