From the Guidelines
A controlled enterocutaneous fistula is characterized by a well-defined tract, predictable output, intact surrounding skin, and absence of distal obstruction, with effective output collection, skin protection, and nutritional stability, as evidenced by studies such as 1. To achieve this control, several key factors must be considered:
- A single, well-epithelialized opening
- Output of less than 500ml daily
- Drainage into a stoma appliance or wound management system
- Proper skin protection using barrier products
- Careful monitoring of fluid and electrolyte balance
- Nutritional support, which may include enteral nutrition (EN) or parenteral nutrition (PN), as suggested by 1 Management of a controlled enterocutaneous fistula involves a multidisciplinary team approach, including a gastroenterologist, surgeon, and dietitian, to optimize nutritional status and reduce complications, as recommended by 1 and 1. Medications such as octreotide may be used to reduce fistula output, and early nutritional support can decrease the occurrence and severity of fistulas, as demonstrated by 1. The controlled nature of these fistulas allows for better patient comfort, reduced complications, and improved quality of life while awaiting potential spontaneous closure or definitive surgical repair, which typically isn't considered until at least 3-6 months after the initial development of the fistula, as supported by 1 and 1.
From the Research
Definition of a Controlled Enterocutaneous Fistula
A controlled enterocutaneous fistula is typically characterized by:
- Low output (<500 ml/day) 2
- Good control of fistula drainage at the skin level 2
- Ability to manage fluid and electrolyte imbalances 3, 4
- Absence of sepsis or infection 3, 4
Factors Contributing to a Controlled Enterocutaneous Fistula
Several factors contribute to a controlled enterocutaneous fistula, including:
- Adequate nutritional support, which may involve parenteral nutrition (PN) or enteral nutrition (EN) 3, 5, 2
- Effective management of fistula output, which may involve the use of somatostatin or somatostatin analogues 3, 5
- Control of fluid and electrolyte imbalances 3, 4
- Management of sepsis or infection 3, 4
- Multidisciplinary team approach, including a gastroenterologist, interventional radiologist, enterostomal therapist, dietician, social worker, and surgeons 6
Management of a Controlled Enterocutaneous Fistula
The management of a controlled enterocutaneous fistula typically involves:
- Initial stabilization with strict bowel rest and parenteral nutrition (PN) 2
- Transition to oral diet or enteral nutrition (EN) if fistula output is low and drainage is well-controlled 2
- Ongoing monitoring and adjustment of nutritional support as needed 5, 2
- Consideration of home parenteral nutrition (HPN) support for long-term management 5, 2