title: A ten-year review of enterocutaneous fistulas after laparotomy for trauma.
abstract: BACKGROUND
  In the era of open abdomen management, the complication of enterocutaneous fistula (ECF) seems to be increasing in frequency. In nontrauma patients, reported mortality rates are 7% to 20%, and spontaneous closure rates are approximately 25%. This study is the largest series of ECFs reported exclusively caused by trauma and examines the characteristics unique to this population.
  
  
  METHODS
  Trauma patients with an ECF at a single regional trauma center over a 10-year period were reviewed. Parameters studied included fistula output, site, nutritional status, operative history, and fistula resolution (spontaneous vs. operative).
  
  
  RESULTS
  Approximately 2,224 patients received a trauma laparotomy and survived longer than 4 days. Of these, 43 patients (1.9%) had ECF. The rate of ECF in men was 2.22% and 0.74% in women. Patients with open abdomen had a higher ECF incidence (8% vs. 0.5%) and lower rate of spontaneous closure (37% vs. 45%). Spontaneous closure occurred in 31% with high-output fistulas, 13% with medium output, and 55% with low output. The mortality rate of ECF was 14% after an average stay of 59 days in the intensive care unit.
  
  
  CONCLUSIONS
  With damage-control laparotomies, the traumatic ECF rate is increasing and is a different entity than nontraumatic ECF. Although the two populations have similar mortality rates, the trauma cohort demonstrates higher spontaneous closure rates and a curiously higher rate of development in men. Fistula output was not predictive of spontaneous closure.
authors.affiliation: Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. pfischer@utmem.edu
authors.forename: Peter E
authors.initials: PE
authors.lastname: Fischer
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Fabian
authors.forename: Louis J
authors.initials: LJ
authors.lastname: Magnotti
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Schroeppel
authors.forename: Tiffany K
authors.initials: TK
authors.lastname: Bee
authors.forename: George O
authors.initials: GO
authors.lastname: Maish
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Savage
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Laing
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Barker
authors.forename: Martin A
authors.initials: MA
authors.lastname: Croce
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D005260:Female; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D007412:Intestinal Fistula / Q000453:epidemiology / Q000209:etiology*; D007813:Laparotomy; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery*