A ten-year review of enterocutaneous fistulas after laparotomy for trauma

Peter Fischer, Timothy Fabian, Louis J. Magnotti, Thomas J. Schroeppel, Tiffany K. Bee, George O. Maish, Stephanie A. Savage, Ashley E. Laing, Andrew B. Barker, Martin Croce

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: In the era of open abdomen management, the complication of enterocutaneous fistula (ECF) seems to be increasing in frequency. In nontrauma patients, reported mortality rates are 7% to 20%, and spontaneous closure rates are approximately 25%. This study is the largest series of ECFs reported exclusively caused by trauma and examines the characteristics unique to this population. Methods: Trauma patients with an ECF at a single regional trauma center over a 10-year period were reviewed. Parameters studied included fistula output, site, nutritional status, operative history, and fistula resolution (spontaneous vs. operative). Results: Approximately 2,224 patients received a trauma laparotomy and survived longer than 4 days. Of these, 43 patients (1.9%) had ECF. The rate of ECF in men was 2.22% and 0.74% in women. Patients with open abdomen had a higher ECF incidence (8% vs. 0.5%) and lower rate of spontaneous closure (37% vs. 45%). Spontaneous closure occurred in 31% with high-output fistulas, 13% with medium output, and 55% with low output. The mortality rate of ECF was 14% after an average stay of 59 days in the intensive care unit. Conclusion: With damage-control laparotomies, the traumatic ECF rate is increasing and is a different entity than nontraumatic ECF. Although the two populations have similar mortality rates, the trauma cohort demonstrates higher spontaneous closure rates and a curiously higher rate of development in men. Fistula output was not predictive of spontaneous closure.

Original languageEnglish (US)
Pages (from-to)924-928
Number of pages5
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume67
Issue number5
DOIs
StatePublished - Dec 1 2009

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Intestinal Fistula
Laparotomy
Wounds and Injuries
Fistula
Abdomen
Mortality
Trauma Centers
Nutritional Status
Population
Intensive Care Units
History
Incidence

All Science Journal Classification (ASJC) codes

  • Surgery
  • Critical Care and Intensive Care Medicine

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A ten-year review of enterocutaneous fistulas after laparotomy for trauma. / Fischer, Peter; Fabian, Timothy; Magnotti, Louis J.; Schroeppel, Thomas J.; Bee, Tiffany K.; Maish, George O.; Savage, Stephanie A.; Laing, Ashley E.; Barker, Andrew B.; Croce, Martin.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 67, No. 5, 01.12.2009, p. 924-928.

Research output: Contribution to journalArticle

Fischer, P, Fabian, T, Magnotti, LJ, Schroeppel, TJ, Bee, TK, Maish, GO, Savage, SA, Laing, AE, Barker, AB & Croce, M 2009, 'A ten-year review of enterocutaneous fistulas after laparotomy for trauma', Journal of Trauma - Injury, Infection and Critical Care, vol. 67, no. 5, pp. 924-928. https://doi.org/10.1097/TA.0b013e3181ad5463
Fischer, Peter ; Fabian, Timothy ; Magnotti, Louis J. ; Schroeppel, Thomas J. ; Bee, Tiffany K. ; Maish, George O. ; Savage, Stephanie A. ; Laing, Ashley E. ; Barker, Andrew B. ; Croce, Martin. / A ten-year review of enterocutaneous fistulas after laparotomy for trauma. In: Journal of Trauma - Injury, Infection and Critical Care. 2009 ; Vol. 67, No. 5. pp. 924-928.
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AU - Fabian, Timothy

AU - Magnotti, Louis J.

AU - Schroeppel, Thomas J.

AU - Bee, Tiffany K.

AU - Maish, George O.

AU - Savage, Stephanie A.

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AU - Barker, Andrew B.

AU - Croce, Martin

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N2 - Background: In the era of open abdomen management, the complication of enterocutaneous fistula (ECF) seems to be increasing in frequency. In nontrauma patients, reported mortality rates are 7% to 20%, and spontaneous closure rates are approximately 25%. This study is the largest series of ECFs reported exclusively caused by trauma and examines the characteristics unique to this population. Methods: Trauma patients with an ECF at a single regional trauma center over a 10-year period were reviewed. Parameters studied included fistula output, site, nutritional status, operative history, and fistula resolution (spontaneous vs. operative). Results: Approximately 2,224 patients received a trauma laparotomy and survived longer than 4 days. Of these, 43 patients (1.9%) had ECF. The rate of ECF in men was 2.22% and 0.74% in women. Patients with open abdomen had a higher ECF incidence (8% vs. 0.5%) and lower rate of spontaneous closure (37% vs. 45%). Spontaneous closure occurred in 31% with high-output fistulas, 13% with medium output, and 55% with low output. The mortality rate of ECF was 14% after an average stay of 59 days in the intensive care unit. Conclusion: With damage-control laparotomies, the traumatic ECF rate is increasing and is a different entity than nontraumatic ECF. Although the two populations have similar mortality rates, the trauma cohort demonstrates higher spontaneous closure rates and a curiously higher rate of development in men. Fistula output was not predictive of spontaneous closure.

AB - Background: In the era of open abdomen management, the complication of enterocutaneous fistula (ECF) seems to be increasing in frequency. In nontrauma patients, reported mortality rates are 7% to 20%, and spontaneous closure rates are approximately 25%. This study is the largest series of ECFs reported exclusively caused by trauma and examines the characteristics unique to this population. Methods: Trauma patients with an ECF at a single regional trauma center over a 10-year period were reviewed. Parameters studied included fistula output, site, nutritional status, operative history, and fistula resolution (spontaneous vs. operative). Results: Approximately 2,224 patients received a trauma laparotomy and survived longer than 4 days. Of these, 43 patients (1.9%) had ECF. The rate of ECF in men was 2.22% and 0.74% in women. Patients with open abdomen had a higher ECF incidence (8% vs. 0.5%) and lower rate of spontaneous closure (37% vs. 45%). Spontaneous closure occurred in 31% with high-output fistulas, 13% with medium output, and 55% with low output. The mortality rate of ECF was 14% after an average stay of 59 days in the intensive care unit. Conclusion: With damage-control laparotomies, the traumatic ECF rate is increasing and is a different entity than nontraumatic ECF. Although the two populations have similar mortality rates, the trauma cohort demonstrates higher spontaneous closure rates and a curiously higher rate of development in men. Fistula output was not predictive of spontaneous closure.

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