ABSTRACT
Enterocutaneous fistulas (ECFs) represent a catastrophic problem for patients and continue to be complex and labor-intensive issues for healthcare providers. In addition to the many physiologic and mental stressors that patients must endure, the development of ECFs also strains healthcare systems, resulting in prolonged hospital stays, multiple readmissions, and increased resource consumption. The management of ECFs has improved significantly, resulting in decreased mortality rates, from 50% in the 1950s to approximately 5–15% at present. Despite overall improvements in the care of these patients with ECFs, sepsis and malnutrition remain the leading causes of death. Postoperative ECFs are more common than spontaneous fistulas. They are often caused by unrecognized bowel injuries or anastomotic breakdown. Multiple preoperative patient factors can increase the likelihood of ECF development. These factors include previous and active infection, inflammatory bowel disease especially active disease, uncontrolled diabetes, electrolyte abnormalities, smoking, malnutrition, anemia, hypothermia, poor oxygen delivery, and emergent procedures.
