ECFs

Pendahuluan
Fistula
hubungan abnormal
2 permukaan Epitel
Mortaliti rate 6.5 to 21%.
 ETIOLOGI
Congenital
Langka
Due to the complete failure of Vitellointestinal duct to obliterate.
Fecal matter at umbilicus after post natal slough of the stump.

Trauma
Trauma tusuk abdomen.
Damage control laparotomy (2% to 25%).

Infeksi
Absces atau invasive intestinal infections seperti amoebiasis,
coccidiomycosis, tuberculosis
Intestinal perforation pada ileum

Perforation or Injury with Abscess & Operative complications

75-85% are iatrogenic - after surgery for bowel obstruction, cancer, or IBD
5> Inflammation, Irradiation or Tumour :

- Crohns disease may cause ECF post op more common

than spontaneous.

- ECF after anastomosis/appendicectomy/simple exploration

in Crohns disease.

- Irradiation for pelvic malignancies etc may lead to a chronic

non-healing ECF.
 Classification
1 Anatomy 2 Fisiologi
Internal High-output
Moderate-output
external Low-output
 Etiologi
Crohns fistula
Radiation-induced fistula
Iatrogenic fistula
 Fisiologi
Low-output (<200 ml/hari)
Moderate-output (200-500
ml/hari)
High-output (>500 ml/hari)
 MANAGEMENT
5
Langkah Recognition &
Investigation stabilization
Decision
Definitive Treatment
Healing
 Recognition & Stabilization
24-48 jam
Mengganti cairan & elektrolit (Utama)
Mencegah infeksi
Nutrisi yang optimal
Kontrol fistula output
Perawatan Kulit luka

1
 Investigation
7-10 Hari

Fistulagram to define
anatomi

2
Decision
10 hari 6 minggu

Decide duration of
nonoperative