43/M c/o sero-enteric discharge from previous operated scar on & off since 2 yrs. underwent open appendectomy 30 yr ago and resurgery in immediate post-op period (? indication). no other medical issues and no similar episode in last 28 yr since last Sx. o/e afebrile GC fair. P/A soft, no tender / mass, on cough impulse this is the VDO. CECT Abdomen reported enterocutaneous fistula. further management? from here.


Entero-cutaneous fistula. Rule out distal obstruction since fistula is for the last two years, likely due to the adhesions. Rx Laparotomy , adhenolysis with resection of the affected part with end to end anastomosis after proper preparation, control of infection, anaemia and nutrition.
Properly going thru CT should give a fair idea about distal obstruction. If there is reasonable calibre of bowel continuity.. it can be treated like a loop stoma closure of sorts. Formal laparotomy is only reqd probably if distally obstructed
Sir, could a plain fistulogram have sufficed? Plan would be:- Laparotomy and proceed. Adhesiolysis with resection-anastamosis will be required. Followed by covering with omentum. Ruling out distal obstruction, building up of nutrition in preoperative period and infection control goes without saying. Consent for stoma, recurrence of ECF and occurrence of incisional hernia to be explained.
Absolutely agree Dr. Planning CT fistulogram and CT enteroclysis. Clinically he has no issues. Well built and nourished. This should give important information in final treatment plan. As suggested Dr PK Goyal we have to look out for distal obstruction most likely adhesions. Thank you for reply. Would update work up

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Low output Ec fistula with incisional hernia Conservative management for atleast 6-8 weeks if no other contraindication like distal obstruction Parenteral nutrition either supplemental or total shld be added Treating sepsis the first priority Wound care, nutrition,etc
Fistulogram, CECT abdomen and pelvis, Colonoscopy to rule out distal obstruction . Resection of fistula tract , resection and end toend anastomosis of smallgut
Low output entero cutaneous fistula.. 4Rs along with SNAP
Recheck biopsy for possibility of Crohn's disease
Observe 3-4 weeks since it is a low output fistula. If no improvement go for fistulectomy
Incisional hernia with entero-cutaneous fistula...
No hernia sir. Pt only complaint minimal discharge intermittently since 2 yr. Says opening closes spontaneous and reopen in couple of months. Initially thought sinus but presently as visualised that minimal discharge is bilio-enteric as evident on axial CT cuts too. Presently he is leading a routine normal life except discharge which more of nuisance than significant complaint. Here decision.. should he go Mx vs Sx. Here Sx is not without risk of leak/other post op complications. From our forum most obviously advice Sx. I given both options and I don't know if he comes back for Sx.

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@Agrima Mullick See this ECF
First f fistulactomy and Needs 2 open abd....
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