Jashvin: Added basic info about the case & setup

2022-07-22T11:48:10Z

Added basic info about the case & setup

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{{Infobox surgical procedure
| anesthesia_type = General
| airway = ETT
| lines_access = 20G IV+
| monitors = Standard, 5-lead EKG
| considerations_preoperative = Possible SBO, Full stomach considerations
| considerations_intraoperative =
| considerations_postoperative = NG decompression until bowel function returns
}}

Enteric Fistulae can occur between the bowel and adjacent tissue including but not limited to: abdominal wall, loops of intestine (enteroenteric, enterocolic), enterovesical, enterovaginal. Surgical repair involves excision of the fistula and separating the organs.

With optimal nonoperative management a fistula may heal spontaneously, the majority within the first 4 weeks after development. Definitive surgical treatment is best achieved with resection of the bowel containing the fistula and anastomosis of healthy normal bowel. The timing of definitive surgery appears to be optimal months after development, if tolerated. Death rates are low after surgery and patients who experience the recurrence of a fistula after initial attempt at closure can ultimately still be cured. <ref>{{Cite journal|last=Ross|first=Howard|date=2010-09|title=Operative Surgery for Enterocutaneous Fistula|url=http://www.thieme-connect.de/DOI/DOI?10.1055/s-0030-1262987|journal=Clinics in Colon and Rectal Surgery|language=en|volume=23|issue=03|pages=190–194|doi=10.1055/s-0030-1262987|issn=1531-0043|pmc=PMC2967319|pmid=21886469}}</ref>

== Overview ==

=== Indications ===

=== Surgical procedure ===

== Preoperative management ==

=== Patient evaluation ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|General Endotracheal Anesthesia
|-
|Neurologic
|
|-
|Cardiovascular
|
|-
|Pulmonary
|
|-
|Gastrointestinal
|Malnutrition, dehydration
Consider full stomach.

NG decompression until return of bowel function post op
|-
|Hematologic
|
|-
|Renal
|
|-
|Endocrine
|Etiology: can be due to carcinoma
|-
|Other
|
|}

=== Labs and studies ===

=== Operating room setup ===
Standard setup with 1 good IV

=== Patient preparation and premedication ===

=== Regional and neuraxial techniques ===

== Intraoperative management ==

=== Monitoring and access ===
Standard monitoring

1 good IV

=== Induction and airway management ===
Possible SBO and full stomach precautions with Rapid Sequence Intubation to prevent pulmonary aspiration.

Patient may be hypovolemic from lack of nutritional support, consider volume load prior to or after induction.

=== Positioning ===
Supine

Lithotomy access to the anus is helpful

=== Maintenance and surgical considerations ===

=== Emergence ===

== Postoperative management ==

=== Disposition ===
Inpatient

=== Pain management ===
IV vs Epidural analgesia

=== Potential complications ===
Sepsis

Ileus

PONV

== Procedure variants ==

{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
!Variant 2
|-
|Unique considerations
|
|
|-
|Position
|
|
|-
|Surgical time
|
|
|-
|EBL
|50-200cc
|
|-
|Postoperative disposition
|
|
|-
|Pain management
|
|
|-
|Potential complications
|
|
|}

== References ==

[[Category:Surgical procedures]]

Closure of enteric fistula - Revision history

Jashvin: Added basic info about the case & setup