Conservative management of a high output enterocutaneous fistula in abdominal tuberculosis

This case review discusses the importance of providing a holistic approach to the care of a patient with two stomas and an enterocutaneous fistula. In this case, the stomas and fistula significantly affected the patient; not just physically but emotionally and socially. The different challenges that arose in pouching a high-output ileostomy, enterocutaneous fistula and ileal conduit with Foley catheter in situ are explored. It also delves into the various options for discharging a patient with complex ostomy complications requiring different needs and resources. Finally, it aims to highlight the therapeutic comprehensive care the stomal therapy nurse provided to the patient and their family.

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A prospective study on appendicular mass

International Surgery Journal ◽

10.18203/2349-2902.isj20211005 ◽

2021 ◽

Vol 8 (4) ◽

pp. 1114

Author(s):

K. Ravichandran ◽

R. Jayaraman ◽

K. Nithya

Keyword(s):

Prospective Study ◽

Conservative Management ◽

Enterocutaneous Fistula ◽

Wound Dehiscence ◽

Final Diagnosis ◽

College Hospital ◽

Duration Of Surgery ◽

Interval Appendicectomy ◽

A Prospective Study ◽

Appendicular Mass

Background: The immediate management of appendicular mass have always been controversial. Early appendicectomy (within 72 hours of presentation) is preferred in some cases, while in others non operative conservative management is advocated. Usually successful conservative management (Ochsner Sherren regimen) is followed by interval appendicectomy (6-8 weeks later). This study determines the outcome of different modalities of intervention in patients with appendicular mass.Methods: A prospective study was conducted in Rajah Muthiah medical college hospital in department of general surgery from June 2018 to December 2020, in cases diagnosed to have appendicular mass. A total of 116 patients were included. After taking detailed history and clinical examination, relevant blood and radiological investigations, were done to achieve the final diagnosis. Presentation, examination findings, investigations, type of surgery, duration of surgery, post-operative complications and duration of hospital stay were studied. Data was collected, compiled, tabulated and analysed.Results: Conservative management followed by interval appendicectomy had lesser incidence of complications like Intraoperative adhesions, surgical site infection, wound dehiscence and enterocutaneous fistula. It also had relatively lesser operative time and lesser period of hospital stay.Conclusions: On comparing the different modalities of intervention, conservative management followed by interval appendicectomy is quite effective and safe method of treatment, with less operative difficulties and better outcome.

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The Successful Conservative Management of High-Output Entero-Cutaneous Fistulae

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.1973.tb07327.x ◽

1973 ◽

Vol 43 (2) ◽

pp. 140-143 ◽

Cited By ~ 1

Author(s):

J. Cocks ◽

R. Jones ◽

R. Keknutt ◽

J. O'Donovan

Keyword(s):

Conservative Management ◽

High Output

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Medical Management of the High-Output Enterostomy and Enterocutaneous Fistula

Atlas of Intestinal Stomas ◽

10.1007/978-0-387-78851-7_8 ◽

2011 ◽

pp. 97-109

Author(s):

Neha Parekh ◽

Douglas L. Seidner

Keyword(s):

Medical Management ◽

Enterocutaneous Fistula ◽

High Output

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Enterocutaneous Fistula Developing In The Scar of an Appendicectomy With an Abdominal Tuberculosis: A Case Report

10.47363/jmhc/2019(1)103 ◽

2019 ◽

pp. 1-2

Author(s):

Arimino S ◽

◽

Arijainalalao NH ◽

Rakotomena D ◽

◽

...

Keyword(s):

Case Report ◽

Enterocutaneous Fistula ◽

Abdominal Tuberculosis ◽

Short Term

Varying forms of enterocutaneous fistula are described in the literature. In all cases, they have a functional, esthetic and even vital impact. The treatment may be complex because of the risk of a recurrence. We report the case of an enterocutaneous fistula developing in the short-term of an appendectomy at Mc Burney’s point associated with an abdominal tuberculosis. The treatment of the tuberculosis has been essential to ensure the success of the surgery. Keywords: Appendicitis, Enterocutaneous Fistula, Pathology, Surgery, Tuberculosis

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Role of Deliberate Creation of Control Enterocutaneous Fistula in Patients of Abdominal Tuberculosis with Perforation of Small Bowel and Matted Small Intestine

Annals of King Edward Medical University ◽

10.21649/akemu.v12i2.879 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Muhammad Hassan Abbas ◽

Kamran Ali ◽

Mahbood Bari ◽

Ahmad W ◽

Anwer M ◽

...

Keyword(s):

Small Intestine ◽

Small Bowel ◽

Surgical Procedure ◽

Anterior Abdominal Wall ◽

Enterocutaneous Fistula ◽

Abdominal Tuberculosis ◽

Therapeutic Trial ◽

Life Saving ◽

Operative Findings

Objective: To study the results after forming the controlled enterocutaneous fistula in the patient of abdominal tuberculosis with matted and perforated small bowel. Design, place and duration of study This study based on therapeutic trial and conducted in one and half years from january1999 to june2001 at Mayo Hospital, Lahore. Patients and methods: All these 20 patients either operated in emergency or on elective list were malnourished, toxic and their operative findings were almost the same , these patients had extensively matted, friable and perforated gut. In these patients it was technically not possible to perform some definite procedure like right haemecolectomy or ileostomy with out increasing the morbidity or mortality. Under these circumstances, minimal surgical procedure which can be life saving is to oppose the anterior abdominal wall to the perforation and thus create a controlled enterocutaneous fistula. In 11 patients fistula closed on its own and in eight patients fistula remained patient and needed re-exploration and repair. Conclusion: This new method of treatment has yielded excellent results. We were able to cure the disease with no mortality. It is recommended that in cases of TB peritonitis with perforation and matted gut making of a controlled enterocutaneous fistula saves the life of the patient.

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Outcome and management of postoperative enterocutaneous fistula

International Surgery Journal ◽

10.18203/2349-2902.isj20205365 ◽

2020 ◽

Vol 7 (12) ◽

pp. 4112

Author(s):

Dinesh Chandra Sharma ◽

Gaurav Jalendra ◽

Pugazhenthi M. ◽

Amit Kumar

Keyword(s):

Enterocutaneous Fistula ◽

Electrolyte Imbalance ◽

Electrolyte Balance ◽

High Morbidity ◽

First Line ◽

Sepsis Management ◽

Time Treatment ◽

Fistula Healing ◽

And Control ◽

High Output

Background: Approximately 75% of enterocutaneous fistula (ECF) occur following surgery. Due to the high morbidity and mortality associated with ECF, prompt and effective treatment is important. This study was conducted to study the outcome and management of patients with enterocutaneous fistula.Methods: Total 40 patients developing the enterocutaneous fistula following surgery were included. All patients were treated either conservatively or operatively by various means and varying period of time. Treatment was focused on the correction of dehydration, controlling sepsis, management of electrolyte imbalance and nutritional support.Results: Overall 40 patients were included in this observational study, comprising 26 were males and 14 were females. About 97.5% of ECF were postoperative. Ileum was found to be the most common site of ECF. Also, 42.5% of fistulas were high output and 57.5% were low output. Serum albumin levels correlated significantly with fistula healing and mortality. Surgical intervention was required in 37.5% of patients.Conclusions: Conservative management with emphasis on improvement of nutrition, control of sepsis, management of fluid and electrolyte balance and control of fistula output is first line of management. Operative intervention must be done in selectively after cases after aggressive and targeted measures for improvement of nutritional status and control of infection.

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A prospective study of cases of intestinal obstruction and role of conservative expectant management

International Surgery Journal ◽

10.18203/2349-2902.isj20182220 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2191 ◽

Cited By ~ 1

Author(s):

Yuktansh Pandey

Keyword(s):

Intestinal Obstruction ◽

Prospective Study ◽

Conservative Management ◽

Expectant Management ◽

Abdominal Tuberculosis ◽

Acute Intestinal Obstruction ◽

Age Group ◽

Abdominal Adhesions ◽

Tract Infections ◽

A Prospective Study

Background: Intestinal obstruction continues to be a common surgical emergency throughout the world and its management protocol has evolved over years. In our study we aimed to provide a complete epidemiological description of intestinal obstruction in adult age group patients in a tertiary care hospital in Northern India.Methods: This is a prospective study of patients belonging to age group more than 12 years admitted in our unit with clinical features suggestive of intestinal obstruction from September 2011 to December 2013 at R. N. T. Medical College, Udaipur. The study comprised of 134 patients.Results: Intestinal obstruction contributed to 6.5% of all surgical admissions. It was nearly twice more common in males. 43% patients presented with features of acute intestinal obstruction in comparison to 57% who presented with features of sub-acute intestinal obstruction. Most common cause observed was obstruction due to intra-abdominal adhesions followed by abdominal tuberculosis 48 and 29 percent respectively. Features of intestinal obstruction resolved in 60% patients with conservative management. Adhesions, abdominal tuberculosis and malignancy counted for majority of patients with sub-acute obstruction. Emergency surgery was done in 32% of patients and 36.5 % of patients were discharged non-operatively. Planned Surgery after successful expectant management was done in 24 % patients. Most frequently seen complication was wound site collection (72.5%) followed by respiratory tract infections (49%). Total mortality in our study was 12.6% of which 41% was post-operative mortality and 59% mortality seen in patients who expired during conservative management. Conclusions: This study demonstrates that intra-abdominal adhesions and abdominal tuberculosis account for most cases of intestinal obstruction in countries like India. A watchful expectant management can be tried in patients with prior operative history and those with history of tuberculosis.

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