Management of Enterocutaneous Fistula: An Eleven-Year Experience from A Tertiary Hospital in North-Western Nigeria
Bello M. Bashir and Ibrahim U. Abubakar
Background: Enterocutaneous fistula is still a problem in tropical Africa. It is commonly associated with emergency abdominal procedures, complicated hernias or trauma. It may also arise spontaneously from advanced intra-abdominal malignancies or tuberculosis. Management remains a challenge in our environment due to the associated malnutrition, sepsis, and fluid and electrolyte abnormalities. Most fistulas will close spontaneously if there is no distal obstruction, epithelialization of the tract, abscess cavity or malignancy. High-output fistulas often require surgical intervention after initial resuscitation. Aim: To look at the pattern of Entero-cutaneous Fistula presentation, its outcome common risk factors, Management and Prognosis indicators in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, North-Western Nigeria. Methodology: An eleven-year retrospective study in which the case note of all patients with a confirmed diagnosis of enterocutaneous fistula between January 2010 and December 2020 was retrieved reviewed and analyzed using the Statistical Package for Social Sciences (SPSS) Version 22 Inc Chicago USA. Results: A total of 200 patients were managed with the highest incidence of 12.5% (25) in 2014. Age range: 17 – 80 years, Mean age: 30.81 years ±8.031 SD and, Median age: 28.00 years. Male to Female ratio = 2.7:1, majority of the fistulae were a result of post laparotomy from typhoid fever (32%), post appendix surgery (30%), post obstetrics and Gynaecology surgery (22%). Most of the fistulas were low output 59.5% while 40.5% were high output. Many of the patients were severely malnourished 43.5%. most of the patients had spontaneous closure 60% with a mortality rate of 32.5%. Conclusion: Enterocutaneous fistula remained a problem in our environment and occurred commonly among males within the younger population. There is a high rate of spontaneous closure with double-digit mortality.