Martínez-Ordaz JL, Luque-de León E, Román-Ramos R, Juárez-Oropeza MA, Méndez-Francisco JD

Language: Spanish
References: 13
Page: 394-399
PDF size: 366.02 Kb.

ABSTRACT

Background: End-ileostomy or colostomies are constructed for source control in patients with severe abdominal sepsis. After takedown, enterocutaneous fistula represents one of the most feared complications.
Methods: A prospective base was created with all patients that underwent, during a 90 month period, end-ileostomy or colostomy takedown after abdominal sepsis. Pre-, intra- and postoperative data were obtained to identify the factors related to enterocutaneous fistula.
Results: There were 293 patients. Thirty patients (10%) developed enterocutaneous fistulas. In twenty-four patients the site was at the anastomosis. Identified risk factors related to enterocutaneous fistula were ASA score III or higher (p‹ 0.01), ostomy takedown >365 days after its creation (p‹ 0.05), reoperation (p‹ 0.001) and anastomotic dehiscence (p‹ 0.001). Of these patients, twenty (67%) had spontaneous closure of the fistula, and three more (10%) had surgical closure, and three patients (10%) died.
Conclusions: Ten percent of patients develop enterocutaneous fistula after end –ileostomy or colostomy takedown. Patient selection and delaying time of surgery to obtain complete recovery of the patient are the most important factors to avoid this complication. Prognosis is related to the characteristics of the fistula (output and site) and medical treatment.

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