An enterocutaneous fistula, as the name implies, refers to the spillage (outflow) of the contents of the gastrointestinal digestive tract outside the intestine or into the abdominal cavity via the diseased part of the intestine. This is the most common type of fistula. The other type of fistula is intra-intestinal, in which digestive juices flow to other organs near the site of the lesion, such as duodenocolonic fistula, small intestine-small intestine fistula, intestinal bladder fistula, intestinal vaginal fistula. Most enterocutaneous fistulas are a complication after surgical and gynecological procedures and are not a common or frequent occurrence. It can be seen after surgery for gastric, colon, and rectal cancers, as well as after major gastrectomy, duodenal surgery, and partial small bowel resection. It can also be seen after emergency surgical procedures, such as appendicitis, car accident trauma, abdominal stab wounds, and acute intestinal obstruction; and also after gynecological procedures, such as ovarian cancer surgery and cervical cancer surgery. In addition, a small percentage of enterocutaneous fistulas do not have a history of abdominal surgery, but are spontaneous, such as Crohn’s disease combined with intestinal and extraintestinal fistulas.
The diagnosis of enterocutaneous fistulas is relatively uncomplicated. However, it is not enough to identify the presence of an enterocutaneous fistula, but a systematic and complete imaging and endoscopic examination is needed to fully understand the site of the fistula, the condition of the sinus tract, the intra-abdominal cavity and the entire gastrointestinal tract.
Enterocutaneous fistula is a “long course” disease that requires a “long war”. Most fistulas take as little as three months to treat and as long as six months or more. A small number of patients with fistulas, such as duodenal fistulas, jejunostomy fistulas, and gastric fistulas, are cured in about two to four weeks. It is not only that the entire course of treatment is long, but also that the medical costs are high. If the treatment goes well, there are no major complications, and the type of fistula is simple and treated non-surgically, the cost can be between $70,000 and $100,000. If the treatment is surgical, the cost is more than $100,000. If there are major complications, or if the fistula is complex, the cost will be higher.
The treatment of intestinal fistula is divided into three stages: stabilization and evaluation, maintenance, and definitive treatment. The treatment is broadly divided into “rapid self-healing” non-surgical treatment and definitive surgical treatment. For patients with tubular fistulas, especially those with high intestinal fistula sites, such as duodenal and upper jejunostomy fistulas, “rapid self-healing” non-surgical treatment can be considered, and many such fistulas are often cured by this treatment. I treated a patient who had a combined gastric and duodenal fistula that was eventually healed after 2 weeks of non-surgical treatment. Another type of treatment is definitive surgery, i.e. resection of the intestinal fistula lesion + reconstruction of the digestive tract. The surgical approach is mostly used for patients with labyrinthine fistulas, patients who have failed to respond to non-surgical treatment and patients with multiple or complex fistulas.
Intestinal fistula is a very complex and dangerous disorder. During the treatment of enterocutaneous fistula, we often encounter various life-threatening complications, which we call “five hurdles to overcome”, namely severe abdominal infection, gastrointestinal hemorrhage, water-electrolyte disorders, severe malnutrition and multi-organ dysfunction. Therefore, no fistula is a minor disease.
However, it should be noted that despite the long course and high risk of enterocutaneous fistula, the level of treatment of enterocutaneous fistula in China, under the leadership of our famous surgeon, Academician Li Jieshou, has made great achievements and is a world leader. Our renowned expert, Professor Ren Jian’an, is currently dedicated to the field of intestinal fistula and abdominal infection and has also achieved remarkable results. As a student of Academician Lai Kai-shou and Professor Ren Jian-an, I hope that through my efforts and through continuous research, I will be able to benefit more patients with intestinal fistula.