Shamim Qureshi, Sadaf Sadiq, Mumtaz Maher.
Management of fecal fistula.
J Surg Pak Jan ;12(1):16-8.

Objective: To share our experience of management of faecal fistula so as to establish management protocol. Study Design: A descriptive study Place and Duration: Department of surgery ward-2 of Jinnah Postgraduate Medical Center Karachi, from July 2002 to June 2005. Patients & Methods: Twenty seven patients with a diagnosis of faecal fistula were studied. Demographic variables, cause and outcome were observed and recorded. A three staged strategy was employed in the management. Conservative management of fistula was based on TPN and bowel rest. Results: There were 16 males and 11 females. Mean age was 36 years. Small bowel was the commonest site of fistulation (22) and intestinal tuberculosis was the most common cause. Eighteen were high output fistulas and 9 were of low output. One fistula was complex others were simple. Sixteen responded to the conservative management and their fistulae closed spontaneously. Eleven of them had small bowel fistulas with high output, 5 had large bowel fistulas with low output. Six patients underwent surgery after 4 weeks of conservative management. All had small bowel fistulas with high output. In 2 patients definitive surgery was done in the form of repair of intestinal leak and by-pass of obstructed segment. In 2 cases laparotomy and peritoneal lavage were done. Primary repair was done in 2 patients for high output fistula but lead to anastomotic leak. They were re-explored and exteriorization of loop was done but both died due to sepsis. Two patients underwent surgery after 6 weeks of conservative management 1 due to peritonitis secondary to anastomotic leak and exteriorization of loop was done and other operated for intra-abdominal collection. One patient was operated after 10 weeks of conservative management but deteriorated despite of all measures. There were five deaths 3 after surgery and 2 without any intervention, both of them were outside referrals. Conclusion: The outcome of faecal fistula depends on a host of factors. We recommend proper timing of intervention for a good outcome.

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