Enterocutaneous Fistula
- HIS FRIENDS
- High output (>500cc/hr; low output <200cc/hr), Intestinal perf, Short fistula tract (<2.5cm long)
- Foreign body, Radiation enteritis, IBD/infection, Epithelialization, Neoplasm, Distal obs, Sepsis.
- All → check prealbumin, protect skin, & tx any infection.
- Low Output (<200mL/d) → PO diet, 500mL fluid restriction.
- High Output (>500mL/d) → consider early TPN, octreotide (decreases output).
- If enteroatmospheric → wound vac (just not on bowel), STSG up to fistula.
- After 6-8 wks → unlikely to heal w/o surgery (per SCORE).