Proximal Loop Ileostomy-A Life Saving Approach in ComplicatedEnterocutaneous Fistulas

Abstract

An enterocutaneous fistula (ECF) is a potentially catastrophic postoperative complication. Although the morbidity and mortality associated with ECF have decreased over the past 50 years with modern medical and surgical care, the overall mortality is still surprisingly high, up to 39% in recent literature. It seems prudent, then, for every surgeon to have a thorough grasp of optimal treatment strategies for ECF to minimize their patients' mortality. Ultimately, the algorithm must begin with prevention. Once an ECF is diagnosed, the key to managemnet is to resuscitate and treat sepsis, to control fistula output, to optimize the patient medically and nutritionally and definitive restoration of gastrointestinal continuity. Special mention is given in this article to complicated fistulas such as those with high output,abdominal sepsis and large abdominal defects.There is stress on diversion of fecal matter through ileostomy at a normal site of intestines at a distance of fistula site and damage/devitalized and inflammed gut(Proximal loop ileostomy) and fistula repair at comparatively early stage to prevent the further complications of sepsis and malnutrition.This plan gives a framework for the difficult task of successfully treating the postoperative ECF with a multidisciplinary approach. Keywords: Enterocutaneous fistula, nutritional support, sepsis, Proximal loop ileostomy