title: [Risk factors and evolution of enterocutaneous fistula after terminal ostomy takedown].
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.
authors.affiliation: Servicio de Gastrocirugía del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico. jlmo1968@hotmail.com.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Martínez-Ordaz
authors.affiliation: Servicio de Gastrocirugía del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico.
authors.forename: Enrique
authors.initials: E
authors.lastname: Luque-de León
authors.affiliation: Departamento de Ciencias de la Salud, Universidad Autónoma Metropolitana, Unidad Iztapalapa, Mexico.
authors.forename: Rubén
authors.initials: R
authors.lastname: Román-Ramos
authors.affiliation: Departamento de Bioquímica, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, Mexico.
authors.forename: Marco Antonio
authors.initials: MA
authors.lastname: Juárez-Oropeza
authors.affiliation: Unidad de Investigación Médica en Enfermedades Metabólicas del Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico.
authors.forename: José Domingo
authors.initials: JD
authors.lastname: Méndez-Francisco
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003106:Colon / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007082:Ileum / Q000601:surgery*; D015994:Incidence; D007410:Intestinal Diseases / Q000209:etiology* / Q000628:therapy; D007412:Intestinal Fistula / Q000209:etiology*; D007416:Intestinal Perforation / Q000150:complications; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D010538:Peritonitis / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology* / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors
keywords: colostomy; colostomía; complicaciones quirúrgicas; ileostomy; ileostomía; intestinal fistula; surgical complications