ECF

Question 1

Definition?

Classifications?

Predisposing factors?

What is the most common causes of ECF?

Complications of ECF?

What brings the patient to OT within first 24 hrs? If pt developed complications

Signs of Intraabdominal sepsis?

Answer 1

Abnormal communication lined by granulation tissue between the skin and gastrointestinal tract

May be classified according to
Congenital / Acquired
Etiology (infection, inflammation, malignancy, RT)
• Internal / External
Simple / Complex
Anatomy (EE, EC, colovaginal, vesicocolic)
Physiology (high / low output)

••
Cancer
Crohn’s disease
Infection
• Irradiatan
Intestinal anastomosis
• Ischemia

• anastamosis of bowell

Sepsis»_space; Ab
Malnutrition > TPN + liasie with dieteican
Fluid and electrolyte imbalance > Blood invx + U&E + Replacement

Distal obstruction
• Intraabdominal sepsis

Nausea, vomiting, swinging pyrexia, abdominal tenderness, rigidity, tachycardia, hypotension.

Question 2

Management of Fistula

Answer 2

Management of Fistula (SNAP Approach)

“Management of fistulas requires an MDT approach following initial resuscitation and stabilization using the ABCDE approach, especially in high-output fistulas.”

Then continue stepwise:

⸻

S – Sepsis control
• “First, I’ll control sepsis — following the Sepsis 6 bundle: take blood cultures, give broad-spectrum IV antibiotics, monitor urine output, give IV fluids, check lactate, and provide oxygen.”
• “If there’s an abscess or collection, I’ll arrange for image-guided or surgical drainage.”

⸻

N – Nutrition
• “Next, nutritional support. I’ll involve a dietitian to start total parenteral nutrition (TPN) or enteral feeding if feasible to meet caloric needs and aid healing.”

⸻

A – Anatomy
• “Then, anatomical assessment — I’ll arrange imaging such as CT abdomen with oral and IV contrast, MRI, or fistulogram to define the fistula’s origin, tract, and any distal obstruction.”

⸻

P – Plan (Procedure & Ongoing Care)
• “Ensure adequate fluid and electrolyte replacement guided by daily U&E monitoring.”
• “Protect surrounding skin from excoriation using barrier creams or stoma appliances.”
• “With conservative management, up to 60% of fistulas close spontaneously within a month once sepsis is controlled and obstruction relieved.”
• “If the fistula fails to close or if there’s ongoing sepsis or peritonitis, then definitive surgical management is planned — usually excision of the tract and resection with anastomosis or exteriorization, once the patient is optimized.”

Question 3

Factors preventing spontaneous healing?

Imaging?

Fluid management

Answer 3

• Distal obstruction
• Malignancy
• Infection
• Radiation
• Crohn’s
• Malnutrition
• High output

Imaging?
• CT abdomen and pelvis with contrast (IV & oral)
• Fistulogram
• Locating the fistula.
• To delineate the track length
Locating any distal obstruction

High output fistula: TPN Nutritional assessment are normally performed by a dietician. It is based on a patient’s body weight and how unwell they are. The energy requirement is 25-30 kcal/kg/day for a normal person and 45-55 kcal/kg/day for a patient following extensive trauma. In addition, the protein, fats, glucose, electrolytes and fluids are calculated and adjusted based on regular blood tests