Fecal discharge from laparotomy site

Chief Complaint A 59 y/o female complained of fecal containing discharge from the laparotomy incision site. History She had h/o colon cancer & undergone chemotherapy. 10 days later she came with discharge from the abdominal incision scar. Vitals BP: 125/65 mmhg, Pulse: 89 bpm, Resp rate: 19 pbm, Temp: 98.2 degree F. Examination Physical examination was normal except for the fecaloid discharge from the right lower region in the laparotomy incision site from a surgery. A fistulography shows an enterocutaneous fistula formation. Treatment What could be the cause for this condition? and how to manage?

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As it is a case of entero- cutaneous fistula- most likely due to 1.Anastsomotic leak or 2.An injury to colon during laparoscopic surgery - which got unnoticed or 3.Colonic cancer site getting perforation Further investigations required are A CECT abdomen with double contrast to exactly locate the site of leak, any intra- peritoneal collection. If on CECT- there is exteriorisatipn of entero- cutaneous fistulous tract and no - intra- abdominal collection- conservative treatment of faecal fistula is needed . Otherwise- a definitive surgery is indicated

Enterocutaneous fistula after surgery can be due to anastomotic leak, disruption of enterotomies or missed injury during surgery. Ideally a CECT abdomen with enterography should be done to look for any collection along with delineation of the fistula tract. Can plan for repair with proximal diverting stoma and later repair after documenting healing with a repeat barium study

Enterocutansous fistula after surgery leads to anastomotic leak or missed injury during surgical intervention. Needs further investigation and evaluation to conclude. Conservative treatment till reports complied and assessment and evaluation to surgical intervention required to repair it.

Thanks Dr Dinesh Gupta

Anaestomotic leak occurs in 10% of patients undergoing Resection anastomosis. It can manifest as faecal peritinotis/ faecal fistula In this case appears to be faecal fistula If there is no distal obstruction patient can be managed conservatively with supportive treatment. If the fistula is high output and associated with distal obstruction colostomy should be done


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