Closure of enteric fistula
|Lines and access||
Standard, 5-lead EKG
|Primary anesthetic considerations|
Possible SBO, Full stomach considerations
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. 
|Airway||General Endotracheal Anesthesia|
Consider full stomach.
NG decompression until return of bowel function post op
|Endocrine||Etiology: can be due to carcinoma|
Labs and studies
Operating room setup
Standard setup with 1 good IV
Patient preparation and premedication
Regional and neuraxial techniques
Monitoring and access
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.
Lithotomy access to the anus is helpful
Maintenance and surgical considerations
IV vs Epidural analgesia
|Variant 1||Variant 2|