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Treatment of abscess or disease bowel

If an abscess or disease bowel segments are seen, then drainage of the
abscess or resection of the diseased bowel is performed. If the patient
is too sick to tolerate a resectional procedure, then exteriorization of
the bowel via ileostomy or colostomy is carried out.
Roux-en-Y drainages or a serosal patch can sometimes be used,
especially for a lateral duodenal fistula following a leak after simple
closureof a perforated duodenal ulcer. However , the result of these
procedures are not very encouraging. Convertating a lateral duodenal
fistula into an end fistula with a tube duodenostomy is a good option
but may not be possible in most patients.

Post operatif care
In the post operatative phase of surgical therapy for an ECF, good
nutritional status essential, because healing of the issue and
anastomosis depends on it.

Antibiotic coverage is needed if the operation is performed in the
presence of sepsis. Any flare up of sepsis increases the possibility of
breakdown of the anastomosis and of the abdominal wall closure
( leading to dehiscence. However, unnecessary use of antibiotics can
lead to resistance and should therefore be avoided.

Fluid and electrolyte balance with appropriate correction is also
important, especially in patients with adverse factors / high output
fistula.

Patients who develop spontaneous fistula due to disease need
appropriate therapy during follow up to prevent disease recurrence or
recurrence of ECG. In patient with malignancy related ECF
chemoterapy and radiation, if required, are administered to control the
primary disease.