Phases of management for enterocutaneous fistulae

Phase	Description	Timing
Stabilization	Rehydration Correction of anemia Electrolyte repletion Drainage of sepsis Control of fistula drainage Local skin care measures Commencement of nutritional support	24-48 h
Investigation	Fistulogram to define anatomy CT/US/MRI to localize collections and guide drainage	7-10 d
Decision	Assess likelihood of nonoperative closure Plan therapeutic course Decide optimal surgical timing	7-10 d to 4-6 wk
Definitive therapy	Plan operative approach Bowel resection with end-to-end anastomosis Secure abdominal closure (+/- flap) Gastrostomy Jejunostomy	4-6 wk or if spontaneous closure unlikely
Healing	Continue nutrition support Transition to total oral/enteral feedings Physical and emotional rehabilitation	5-10 d after closure

Phases_of_management_for_enterocutaneous_fistulae.htm

CT: computed tomography; US: ultrasound; MRI: magnetic resonance imaging.

Reproduced with permission from: Fischer JE, Evenson AR. Gastrointestinal-cutaneous fistulae. In: Mastery of Surgery, Fischer JE (Ed), Lippincott Williams & Wilkins 2007. Copyright © 2007 Lippincott Williams & Wilkins. www.lww.com.

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Phases of management for enterocutaneous fistulae