1) Entero-cutaneous fistulas are abnormal connections between the skin and gastrointestinal tract that allow intestinal contents to drain onto the skin.
2) They are usually caused by surgery, trauma, infection, inflammation or radiation and most commonly involve the small intestine.
3) Treatment involves stabilization, controlling sepsis, optimizing nutrition, identifying the fistula anatomy, and eventually either definitive surgical repair or closure of the fistula tract.
Normally, fistula is defined as an abnormal communication between two epithelized surface.But enterocutaneous fistula is an abnormal communication between the skin with various parts of the gut. The ileum is the most common site of origin of enterocutaneous fistula.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Normally, fistula is defined as an abnormal communication between two epithelized surface.But enterocutaneous fistula is an abnormal communication between the skin with various parts of the gut. The ileum is the most common site of origin of enterocutaneous fistula.
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Information about Management of Appendicular Lump by Dr Dhaval Mangukiya.
Details of Appendicular Lump, Basic to Above the Basics, Incidence, Safe Approach Interval Laparoscopy, Early Surgery etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Intestinal fistulas pose the greatest challenge to the General Surgeon. The presentation provides abrief guideline for management of this complex problem.
Ventral hernia is protrusion of peritoneal sac through anterior abdominal wall defects except Groin hernias. In this presentation I have discussed Epigastric, Umbilical, Para umbilical, Incisional, Spigelian and Lumbar hernias.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
Information about Management of Appendicular Lump by Dr Dhaval Mangukiya.
Details of Appendicular Lump, Basic to Above the Basics, Incidence, Safe Approach Interval Laparoscopy, Early Surgery etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
Intestinal fistulas pose the greatest challenge to the General Surgeon. The presentation provides abrief guideline for management of this complex problem.
Gastric Perforation From Peptic Ulcer Disease - A Review of the Surgical Trea...Joseph A. Di Como MD
A PowerPoint presentation reviewing gastric perforation for peptic ulcer disease and a review of the surgical treatment options. Intended for medical professionals and students.
1. Obstructive ileus is a condition characterized by a blockage in the intestines. 2. Ileus obstructive refers to a situation where there is a hindrance in the normal flow of the intestines. 3. The term obstructive ileus is used to describe a condition where there is an obstruction in the intestines, causing a disruption in the normal movement of food and fluids. Ileus refers to the intolerance of oral intake due to inhibition of the gastrointestinal propulsion without signs of mechanical obstruction. The diagnosis is often associated with surgery, medications, trauma, peritonitis, or severe illness. Mechanical obstruction has to be ruled out, and the diagnosis of ileus is dependent on radiographic evidence, usually on a CT scan or small bowel series. This activity reviews the evaluation and management of an Ileus and highlights the role of the interprofessional team in improving care for patients with this condition.
Objectives:
Identify the etiology of ileus.
Outline the typical presentation of a patient with ileus.
Review the management options available for ileus.
Identify interprofessional team strategies for improving care coordination and outcomes in patients with ileus.
Access free multiple choice questions on this topic.
Go to:
Introduction
Ileus, also known as paralytic ileus or functional ileus, occurs when there is a non-mechanical decrease or stoppage of the flow of intestinal contents.[1][2] Bowel obstruction is a mechanical blockage of intestinal contents by a mass, adhesion, hernia, or some other physical blockage. These two diseases may present similarly, but treatment can be very different depending on the underlying pathology.
Ileus is an often unavoidable consequence of abdominal or retroperitoneal surgery, but can also be found in severely ill patients with septic shock or mechanical ventilation. Due to the delayed refeeding syndrome seen after an ileus, postoperative ileus has a large economic impact in the United States alone.[3] An ileus usually manifests itself from the third to the fifth day after surgery and usually lasts 2 to 3 days with the small bowel being the quickest to return to function (0 to 24 hours), followed by the stomach (24 to 48 hours), and lastly the colon (48 to 72 hours).[2][4][5] A prolonged ileus is diagnosed if the ileus exceeds 2 to 3 days with the continued absence of obstruction signs.[6]
Go to:
Etiology
The cause of ileus has yet to be clearly defined. There are, however, several risk factors that have been shown to increase the likelihood and endurance of an ileus.[7]
Prolonged abdominal/pelvic surgery
Lower gastrointestinal (GI) surgery
Open surgery
Retroperitoneal spinal surgery
Opioid use
Intra-abdominal inflammation (sepsis/peritonitis)
Peritoneal carcinomatosis
Perioperative complications (pneumonia, abscess)
Bleeding (intraoperative or postoperative)
Hypokalemia
Delayed enteral nutrition or nasogastric (NG) tube placement
The risk for an ileus is influenced by a variety of fx
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
2. INTRODUCTIONINTRODUCTION
Fistula is defined as an abnormal communication between two epithelialized
surfaces.
Enterocutaneous fistula is an abnormal communication between the skin with
various parts of the gut, such as duodenum, jejunum etc.
The word fistula means a “pipe” or “flute” in Latin.
The ileum is the most common site of origin of Enterocutaneous fistula.
5. ETIOLOGYETIOLOGY
Webster and Carey proposed five mechanisms of fistula formation :
1> Congenital : - Rare
- Failure of obliterate of Vitello-intestinal duct.
- Post natal slough of the stump.
2> Trauma : - Major penetrating trauma.
- Damage control laparotomy techniques
6. 3> Infection : - intra abdominal Abscess and invasive intestinal infections like
amoebiasis, coccidiomycosis, tuberculosis etc.
- Intestinal perforation in ileum from tuberculosis or enteric fever
- Actinomyces infection post appendectomy.
4> Iatrogenic :
- Intra-abdominal abscess
- 75-85% are iatrogenic - after surgery for bowel obstruction,
cancer, or IBD
7. 5> Inflammation, Irradiation or Tumour :
- Crohn’s disease may cause ECF – post op more common
than spontaneous.
- ECF after anastomosis/appendicectomy/simple exploration
in Crohn’s disease.
- Irradiation for pelvic malignancies etc may lead to a chronic
non-healing ECF.
8. PREVENTION OF FISTULAPREVENTION OF FISTULA
- Acute intra-operative perforations- early identification and closure.
- Serosal tears should be repaired immediately.
- Aggressive adhesiolysis should be avoided to prevent serosal
tears.
9. Post operatively anastomotic leak
Fever
Abdominal pain
Continuous drain containing intestinal content
General condition not improving
DIAGNOSIS OF PERFORATION AND FISTULADIAGNOSIS OF PERFORATION AND FISTULA
11. • Stabilization
• Sepsis control
• Skin care
• Nutrition
• Anatomy identification
• Plan to deal with the fistula
MANAGEMENTMANAGEMENT
S-S-N-A-PS-S-N-A-P
12. STABILIZATIONSTABILIZATION
In 24 to 48 hours.
First step - resuscitation and stabilization of the patient.
Initial efforts –
intravenous fluid resuscitation
control of infection
protection of surrounding skin
measuring and replacing ongoing losses.
> Intra-abdominal/subcutaneous abscesses should be drained
13. A. RESUSCITATIONA. RESUSCITATION
Restoration of normal circulating blood volume
correction of electrolyte and acid-base imbalance
Initial management- RL and NS
Strict input and output measurements
CVP monitoring
urinary catheterization.
Ongoing fluid losses should be fully replaced
Associated with hypokalemia and metabolic acidosis- correction.
Output of fistula should be monitored
Urine output should be restored to greater than 0.5mL/kg/hr.
If needed transfuse blood.
14. B. NUTRITIONB. NUTRITION
73% of enteric fistulae closes spontaneously in adequately nourished
patients,
as against 19% in malnourished patients.
> Nutritional support needs to begin as soon as the patient is stabilized.
> Nutrition can be parenteral or enteral route, based on the anatomy
of the fistula.
> Its advisable to provide at least a part of the daily nutritional requirement
through enteral route.(adequate is 25%).
> Nutrition via the enteral route helps in maintaining the intestinal mucosal
barrier, more efficacious delivery of nutrients, stimulating hepatic protein
synthesis.
> ORS should be given when oral intake is possible.
> In proximal fistulae, the enteral feeding tube may be entered beyond the
fistula to provide enteral nutrition.
> It is advisable to enter feeding tube beyond ligament of Treitz for a gastric
or duodenal fistula.
TPN is also given in patients who do not tolerate enteral feeds or have
long standing ileus or before fistulous tract is well established.
15. NUTRITION CONTD..NUTRITION CONTD..
vitamins, trace elements, zinc and up to 10 times the daily requirement of
Vitamin C should be provided.
> Mortality rate of 42% with albumin <2.5 mg/dl v/s 0% if >3.5 mg/dl.
TYPE OF FISTULA CALORIE REQ PROTEIN REQ
Low Output 30-35 kcal/kg/day 1-2 gm/kg/day
High Output 45-50 kcal/kg/day 1.5-2.5 gm/kg/day
16. C. CONTROL OF SEPSIS AND FISTULA EFFLUENTC. CONTROL OF SEPSIS AND FISTULA EFFLUENT
17.
18. D. PHARMACOLOGICAL SUPPORTD. PHARMACOLOGICAL SUPPORT
> Somatostatin analogue Octreotide-100 – 250 mcg TDS reduces
fistula output by 40 – 60% by the end of 24 hrs.
> Should be discontinued if ineffective for 48 hrs (side effects-
hyperglycemia, elevated cholesterol and reduced bowel motility).
> Octreotide and TPN seem to have a synergistic effect on reduction of effluent
volume and improvement in fistula closure rates.
> Proton-pump inhibitors and H2 receptor antagonists also help reduce fistula
output especially in proximal fistulas.
> Complications include URTI, headache, fatigue etc.
19. INVESTIGATIONSINVESTIGATIONS
To locate Fistula
X-ray- show any foreign body
Oral dye / Charcoal – shows presence or absence,
but not its location, cause or anatomy.
USG - locating intra-abdominal abscesses, guided aspiration
Fistulography- length & width of the fistula, anatomical
location, the presence of any distal obstructions
CT Scan- oral and IV- highly recommended for duodenal & pancreatic fistula.
Endoscopy -principal use is in internal fistulas.
20.
21. DECISIONDECISION
Factor Favorable Unfavorable
Organ of origin Esophageal, Duodenal stump,
Pancreatic, Biliary, Jejunal,
Colonic
Gastric, Lateral
duodenal, Ligament of
Treitz, Ileal
Etiology Postop (anast leak),
Appendicitis, Diverticulitis
Malignancy, IBD
Output Low (<200-500cc/day) High (>500cc/day)
Nutritional status Well nourished Malnourished
Sepsis Absent Present
State of bowel Intestinal continuity, absence
of obstruction
Distal obstruction,
Abscess, Discontinuity,
Irradiation
Fistula
characteristics
Tract >2 cm, Defect <1cm Tract <1cm, Defect >1cm
Miscellaneous Original operation at same
institution
Referred from outside
institution
22. 90% of small intestinal fistula which closed spontaneously within a month.
10 % fistulas closes spontaneously after 2 months and none after 3 months
Factors possibly responsible for failure of spontaneous closure are:
Foreign Body
Radiation
Inflammation/ infection
Epithelialization [F-R-I-E-N-D-S]
Neoplasm
Distal intestinal obstruction
Steroids.
24. DEFINITIVE THERAPYDEFINITIVE THERAPY
> 80-90% will close within 6 weeks with conservative management.
> Surgery between 10 days and 6 weeks post-op will encounter the worst
adhesions.
> Preferably wait up to 6 weeks before open exploration and repair of defect,
but in case of fecal fistula, due to intense inflammation, it is prudent to wait
up to 10-12 weeks.
> The patient should by then, be nutritionally optimized, patient should not be septic
and patient should be vitally stable.
25. > Definitive operative correction remains the final step in the treatment of
non-healing small intestinal fistulas.
> In majority of the cases, preferred operation is resection of the involved segment
with primary end-to-end anastomosis.
> However if primary anastomosis is not possible, then both the proximal and
distal ends of intestine are exteriorized.
> In case the fistula is deemed inappropriate for resection, such as when it
develops after a deep pelvic procedure, staged approach involving bypass
should be considered.
26. Basic principles of surgical treatment
• resection of the intestinal segment, fistula tract, and the
adjacent part of the involved structure
• absence of extensive infection or inflammation - primary
anastomosis of the divided intestinal segments and
reestablish GI continuity
• presence of extensive infection - the divided intestinal
segments are exteriorized.
• staged procedure is performed after the infection and
inflammation subsides to re-establish GI continuity and
reconstruction of the affected structure after 10 weeks.
27. Entero-cutaneous fistula :-
Resection of the involved segment with primary end-to-end anastomosis
Exteriorization of both ends in the presence of extensive intra-abdominal
sepsis
Bypass procedure when dense adhesions are encountered within the
pelvis.
Choice of procedure for specific fistula
types
28. Enteroenteric fistula
• In the absence of associated infection:- Primary anastomosis
of healthy bowel ends.
• In the presence of associated infection:- Proximal diversion
procedure with drainage of the abscess cavity.
• Resection of the involved intestine and fistula after 4-6 weeks.
• Resection should be limited to the area of intestine involved in
fistula formation.
• Extensive resection is not advantageous and only increases
the risks of subsequent short-bowel syndrome
and malabsorption.
29. Entero-vesical fistula
• Surgical resection of the diseased intestine and the involved
area of bladder wall.
• A primary anastomosis of the bowel is performed,
• The bladder wall is closed in layers.
• In presence of inflammation- transection of the intestinal
segment proximal and distal to the fistula, leaving the fistula
tract in place. Both ends of the intestine are exteriorized.
30. Nephroenteric fistula
• surgical procedure of choice is either total or partial
nephrectomy, with en-bloc resection of the fistula tract and
the involved intestinal segment. The ends of the intestines are
anastomosed primarily.
31. Enterovaginal fistula
• Surgery is reserved for patients who do not respond to
conservative treatment with antibiotics and drainage of
associated abscesses.
• An en-bloc resection of the involved intestinal segment with
fistula and affected vaginal wall is performed.
• The intestinal ends are anastomosed primarily and the vaginal
defect may be closed primarily.
32. Aortoenteric fistula
• Emergency surgical intervention
• The aortic prosthetic graft is removed
• The intestinal defect is debrided and closed primarily. The
presence of extensive inflammatory or devitalized tissue may
necessitate intestinal resection and an end-to-end
anastomosis.
35. > In 1995, Ho HS and Frey CF used primary closure of gastric fistula with
delayed external drainage as treatment for gastric fistulas.
> If the gastric fistula defect is too large to allow primary closure,then a
Roux-en-Y gastrojejunostomy may be done.
> Duodenal fistulas are usually treated with tube duodenostomy or Roux-en-Y
duodenojejunostomy.
> A feeding jejunostomy distal to the enteroenterostomy should always be
considered.
38. CONCLUSIONCONCLUSION
> Enterocutaneous fistulas are abnormal communication between the gut
and skin.
> Majority of the ECF are due to iatrogenic causes (70-85%). Others include
trauma, congenital causes. Spontaneous ECF may arise due to Crohn’s
disease.
> Malnutrition, Electrolyte imbalances, acid-base imbalances and sepsis are
the major causes of mortality in ECF.
> After initial stabilization of the patient by resuscitation( fluid, electrolytes,
blood transfusions etc), the patient is subjected to various investigations
to determine the location& anatomy of fistula, presence of distal obstruction
etc.
39. > Enteral nutrition is always preferable to parenteral nutrition provided the
patient tolerates enteral feeds.
> Local wound care by application of ostomy bag and pastes are essential.
> Drainage of intra-abdominal abscesses, treatment of sepsis is of utmost
importance.
> After proper optimization, patient undergoes definitive therapy which
includes resection of the fistulous segment of the gut.
> ECF with large abdominal defects may require VAC devices/ biologic mesh
SSG to help close the defect.