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PATHOPHYSIOLOGY
SOETAMTO WIBOWO
DEPT OF SURGERY AIRLANGGA UNIVERSITY
DR. SOETOMO GENERAL HOSPITAL - SURABAYA
GOOD 4 U
ENTEROCUTANEOUS
FISTULAE
SURGEONS ERROR ?
MAL PRACTICE !
CATASTROPHE
PATIENTS FAMILY
DOCTORS NURSES
HOSPITAL
ENTEROCUTANEUS FISTULAE
FISTULA : AN ABNORMAL COMMUNICATION
BETWEEN TWO OR MORE SURFACE OF
EPITHELIUM
ETHIOLOGY (HISTORY)
1945 : SPONTANEOUS - HIGH MORTALITY
1945 -1970 : POST OPERATIVE COMPLICATION
(1968) : PARENTERAL NUTRITION
LOCAL FISTULAE CONTROL
COMBAT SEPSIS
1980 - : MORE AGGRESSIVE OPERATIVE
PROCEDURE
INTERNAL
ENTERO ENTERAL
ENTERO VESICAL
TOTAL 138 25
ENTEROCUTANEOUS FISTULAE
INDIRECT FISTULAE
ENTEROCUTANEOUS FISTULAE
2002 2003
n 18 7 25
LOCATION n %
COLORECTAL 10 (40%)
ILEUM 8 (32%)
APPENDIX 5 (20%)
GASTER 1 (4%)
JEJUNUM 1 (4%)
ENTEROCUTANEUS
FISTULAE
HIGH OUTPUT 8
LOW OUTPUT 17
ENTEROCUTANEOUS
FISTULAE
DIAGNOSTIC :
CONTRAST IMAGING
CT SCAN
FISTULA CLOSED (6)
SURGERY (6)
FISTULA OPEN (-)
LOW OUTPUT
FISTULA E (17)
FISTULA CLOSED (4)
CONSERVATIVE (11)
FISTULA OPEN (4)
LOCAL SYSTEMIC
ADEQUAT BLOOD SUPPLY PATIENT NUTRITION
ABSENCE OF ANASTOMOTIC SEPSIS
TENSION
HEALTHY TISSUE EDGES HYPOVOLEMIA
BACTERIAL CONTAMINATION MEDICATION (E.Q. STEROID)
DISTAL OBSTRUCTION IMMUNO COMPETENCE
RADIATION INJURY BLOOD TRANSFUSION
BOWEL PREPARATION UREMIA
HYPERTHERMIA JAUNDICE
DISTAL OBSTRUCTION
MALIGNANCY
FOREIGN BODY
ASSOCIATED UNDRAINED INFECTION
RADIATION INJURY TO TISSUE
UNDERLYING INFLAMMATORY CONDITION
(E.Q. CROHNS DISEASES, TUBERCULOSA)
MULTIPLE FISTULAE
INTRA ABDOMINAL ABSCESSES
SEPTICAEMIA
ILEUS
ACUTE RESPIRATORY DISTRESS
UPPER GASTRO INTESTINAL TRACT FAILURE
RENAL AND / OR HEPATIC FAILURE
THROMBO EMBOLIC COMPLICATION
McGuire, 1990
CONCLUSIONS