A ten-year review of enterocutaneous fistulas after laparotomy for trauma.
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.
Fischer
Peter E
PE
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. pfischer@utmem.edu
Fabian
Timothy C
TC
Magnotti
Louis J
LJ
Schroeppel
Thomas J
TJ
Bee
Tiffany K
TK
Maish
George O
GO
Savage
Stephanie A
SA
Laing
Ashley E
AE
Barker
Andrew B
AB
Croce
Martin A
MA
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*