The following five types of serious complications can occur at any time during the treatment of enterocutaneous fistula, and we need to actively face and solve them. In the words of Professor Ren Jian’an of Nanjing General Hospital’s Enterocutaneous Fistula Center, it’s “five hurdles to overcome, six generals to defeat”. These complications include: severe infection, gastrointestinal bleeding, severe water, electrolyte and acid-base disorders, severe malnutrition and multiple organ and tissue dysfunction. Among them, severe infection is often a difficult problem for our enterocutaneous fistula doctors. Today we will talk about the common causes of fever during the treatment of patients with enterocutaneous fistula, i.e. common causes of infection, the source of infection.
“Do not simply assume that the patient’s fever is due to a cold, but actively look for the source of the infection”, Professor Ren Jian’an would often refer to this admonition when I was working at the postdoctoral station of general surgery at the Nanjing General Hospital of the Nanjing Military Region. When a patient has a sudden fever, the first thing to think about is whether there is an abdominal infection. This is because the enterocutaneous fistula itself starts with an abdominal infection. After aggressive continuous flushing and drainage with double trocars, the patient’s temperature will improve significantly as the source of infection is adequately controlled. However, when the patient develops high fever again, it is important to consider whether poor drainage is causing the fever and to check that the double cannula is in place and that the flushing and drainage is patent. The presence of sludge and cholecystitis should also be considered. Because patients with enterocutaneous fistulas are often supported by parenteral nutrition for long periods of time, this often causes enlargement of the gallbladder, significant biliary sludge and acute cholecystitis.
In addition to the common abdominal infections, one should look at the possibility of pulmonary infections. Patients with enterocutaneous fistula are mostly bedridden and immunocompromised for long periods of time, and pulmonary infections are often the cause of hyperthermia. Performing pulmonary auscultation, performing chest radiographs and CT lung examinations, and sputum culture tests often clarify the pulmonary situation.
Catheter-associated bloodstream infections. Patients who need long-term parenteral nutrition support often have deep venous catheters placed under them, such as subclavian deep vein placement, internal jugular vein placement, PICC, etc. Patients with long-term parenteral nutrition are prone to intestinal mucosal barrier destruction and bacterial translocation. In addition, as the duration of deep venous catheter placement increases, the likelihood of catheter-associated bloodstream infections becomes greater.
Urinary tract infections. Fever due to urinary tract infections should be thought of in patients with long-term catheter placement. Cystitis is often associated with urinary frequency, urgency, and painful urination. Acute pyelonephritis is also often associated with low back pain. Routine urinalysis and urine culture can help in the diagnosis.
If all of the above factors have been excluded, the patient should also be examined at the peripheral venous indwelling needle to exclude the possibility of peripheral phlebitis. If peripheral phlebitis occurs, localized redness, swelling, and warmth at the site of the indwelling needle and a red line extending along the vein are seen.
Less common causes are mumps, sinusitis, and epididymitis, among others.
Enterocutaneous fistulae have a long course, are complex and have many complications, and often encounter many difficult problems. Symptoms of fever indicate the presence of an infection, and being able to identify the source and site of infection is essential to control it. These are some of the common causes of fever in patients with enterocutaneous fistula. Once these factors have been ruled out, it is not too late to explain the cause of fever with a cold.