title: [Postoperative entero-cutaneus fistulas--a study of 24 cases].
abstract: OBJECTIVE
  To perform a retrospective study on the experience of the Clinic of General, Liver, Biliary and Pancreatic Surgery, Alexandrovska Hospital in the diagnosis and treatment of patients with acquired entero-cutaneus fistulas and to analyse the early postoperative results.
  
  
  METHODS
  We treated 24 patients with postoperative entero-cutaneous fistulas in the period Jan., 2000 - Aug., 2004. The male sex and the age above 50 were dominent. The primary disease was of oncological origin in 22 cases (91.66%). Anemia, hypoprotenemia and hypoalbuminemia were predisposing and risk factors in 19 cases (79.17%). Fistulography was routinely used for establishing the diagnosis. Surgical treatment was received by all the 6 patients (100%) with small bowel fistulas and by 15 from the 18 patients with large bowel fistulas (83.33%). EARLY POSTOPERATIVE RESULTS: The mortality rate was 4.54% (1 fatal outcome from 22 operated patients). The morbidity rate was 36,36% (8 cases) but none of the complications needed a reoperation.
  
  
  CONCLUSIONS
  1. The most frequent causal factor for entero-cutaneus fistulas in our material was an anastomotic leakige after bowel resection (95.83%); 2. The risk for such a coplication is higher in cancer patients with other predisposing pathological factors; 3. From the pahtological and clinical point of view the entero-cutaneus fistulas caused significant disturbances in base-alkaline and electrolyte balance, malnutrition and cahexia; 4. The clinical signs and the fistulography prooved to be reliable diagnostic methods; 5. The preoperative substitution and nutritional therapy had a significant benefit on the postoperative results, especially in cases of small bowel fistulas; 6. The open surgery was the main therapeutical method in the complex treatment of those patients.
authors.forename: K
authors.initials: K
authors.lastname: Draganov
authors.forename: V
authors.initials: V
authors.lastname: Dimitrova
authors.forename: D
authors.initials: D
authors.lastname: Bulanov
authors.forename: D
authors.initials: D
authors.lastname: Rusenov
authors.forename: E
authors.initials: E
authors.lastname: Tosheva
authors.forename: K
authors.initials: K
authors.lastname: Dimitrov
authors.forename: S
authors.initials: S
authors.lastname: Tonev
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D017577:Cutaneous Fistula / Q000209:etiology / Q000601:surgery; D016154:Digestive System Fistula / Q000209:etiology / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome