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WMJ Vol. 118 No. 2: Original Research

Enteric Fistula Treatment and Management: Results of an Institutional Inpatient Treatment Protocol

Nathan W. Kugler, MD; Samuel Boateng, BS; Travis P. Webb, MD; Colleen M. Trevino, PhD


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Introduction: Enterocutaneous fistulae (ECF) are abnormal communications between the gastrointestinal tract and skin that may occur following an abdominal operation and result in significant morbidity and even mortality. Standardized care of patients with ECF has not been implemented at the majority of tertiary hospitals. We sought to evaluate the benefits of a multidisciplinary team utilizing an evidence-based clinical treatment protocol for inpatient management of ECF.

Methods: We performed an Institutional Review Board-approved retrospective analysis of outcomes after the implementation of an evidence-based clinical treatment protocol for patients admitted with ECF to the acute care surgical service at a large academic medical facility. Patients managed prior to the established protocol were considered part of the pre-protocol cohort (pre) while patients managed following implementation were included in the postprotocol cohort (post). A review of all eligible patients’ hospital and clinic medical records was performed.

Results: In the pre cohort (n = 6), the average length of stay was 37 days, ranging from 16-67 days, with a 16% spontaneous closure rate and 60% requiring operative management for closure. A single patient was not offered surgery due to significant comorbidities. The post cohort (n = 13) demonstrated an average length of stay of just 16 days, ranging from 4 to 28 days, with an 84% spontaneous closure rate and 16% requiring operative closure

Conclusion: Utilization of a standardized treatment approach results in high spontaneous closure rates with a decreased hospital length of stay.

Author Affiliations: Medical College of Wisconsin, Department of Surgery, Division of Trauma and Critical Care, Milwaukee, Wis (Kugler, Boateng, Webb, Trevino).

Corresponding Author: Colleen M. Trevino, PhD, Medical College of Wisconsin, Department of Surgery, Division of Trauma and Critical Care, 9200 W Wisconsin Ave, Milwaukee, WI 53226; phone 414.805.8649; email ctrevino@mcw.edu.

Funding/Support: None declared.

Financial Disclosures: None declared.