TITLE:
Prevalence, Management and Outcomes of Enterocutaneous Fistulas in Buea Regional Hospital and Laquintinie Hospital of Douala. A Five Years Retrospective Study
AUTHORS:
Yannick Mahamat Ekani Boukar, Divine Mokake, Ousmana Oumarou, Chimene Cecile Biiga II, Moussa Adam Adami, Eric Patrick Savom, Anutebeh Verdo Zisuh, Guy Aristide Bang, Alain Chichom Mefire, Arthur Essomba, Marcellin Ngowe Ngowe, Maurice Aurelien Sosso
KEYWORDS:
Enterocutaneous Fistula, Prevalence, Management, Outcomes
JOURNAL NAME:
Surgical Science,
Vol.14 No.1,
January
18,
2023
ABSTRACT: Background: An Enterocutaneous fistula (ECF) is an abnormal connection between the
intestinal tracts or stomach and the skin. They are a major catastrophe to the
patient and surgeons and still have a high incidence of morbidity and mortality
which varies between 6% - 33%; their management remains a big challenge. These patients frequently
face complications, and a well-organized
multidisciplinary approach must be implemented in their management to improve
outcomes. Objectives: Our study aims to assess the prevalence, management and outcomes of enterocutaneous fistulas in Buea
regional hospital and Laquintinie hospital of Douala over the past 5 years. Methods: This was a hospital-based retrospective study in Buea regional hospital
and Laquintinie hospital of Douala. Records of patients who had enterocutaneous fistulas within the period of 1st January 2017 to 31st December 2020 in the surgical departments. Data included demographics,
pre-operative diagnosis, comorbidities, type of fistula, management modality
and means, the indication of operative treatment, length of stay in the
hospital and outcomes. Data was analysed
using SPSSv26. Results: The study constituted 1343 medical records of which 83 medical records of patients with enterocutaneous
fistulas, giving a prevalence of 6.2%, female predominance at 59% (n = 49),
42.2% (n = 35) were referred cases from the periphery for better management. A
vast majority (96.4%) occurred as post-operative complications with
appendectomy the most common indication (18.8%). High output fistulas were
predominant (43.4%). 59% (n = 47) were managed medically, 6% (n = 5) received
both conservative and surgical modalities while 35% (n = 5) were managed
surgically. 64.1% (n = 50) were placed on enteral nutrition while 35.9% (n = 28) were placed on parenteral nutrition.
Peritonitis/infection 50% (n = 18) was the commonest indication of surgical
treatment, followed by failure of medical treatment 25% (n = 9) then
high output fistulas 16.7% (n = 6). Resection with end-to-end anastomosis was
the preferred repaired work at 61% (n = 22). The mortality rate was 38.5% (n =
32), 29% (n = 24) healed after conservative treatment, 21.7% (n = 18) healed
after surgery, 7.2% (n = 6) persisted after surgery while 3.6% (n = 3)
persisted after conservative treatment. Anaemia,
sepsis, electrolyte imbalance, dehydration and malnutrition were the commonest
complications. Conclusion: The prevalence of enterocutaneous fistulas
was high, with a female predominance and a mean age of 38 years. Most cases were seen as a referral from the
periphery for better management. The greatest majority of fistulas occurred as
a postoperative complications. Conservative management with enteral feedings
was preferred, they had better outcomes and gave more chances of healing. The
commonest indication of surgical treatment was an infection. Resection with
end-to-end anastomosis was the preferred repaired work. The mortality rate was
high, and anaemia, sepsis and electrolyte imbalance were the commonest
complications.