Cumulative incidence and management of enterocutaneous fistulas owing to laparotomy for penetrating abdominal trauma: a single centre experience

Abstract

Background: Enterocutaneous fistula (ECF) owing to laparotomy for penetrating abdominal trauma (PAT) is rarely reported. The quoted incidence in two recent publications is 1.9% and 1.5%, in 2224 and 2373 patients, respectively. Advances in trauma surgery including damage control surgery and the use of open abdomen techniques, have led to concerns of increasing fistula rates in trauma patients. The purpose of this study was to determine the incidence and outcomes of patients with ECF resulting from penetrating  bdominal trauma.

Methods: A retrospective study including patients who underwent laparotomies for PAT between 01 January 2015 and 31 August 2018 (44 months) was performed. The Groote Schuur Hospital (GSH) Trauma Centre RedCap, GSH Intestinal Failure Unit and the Stoma Therapy department databases were scrutinised by folder review.

Results: Of a total of 965 patients with PAT, 597 underwent laparotomies and 586 had hollow viscus injury (HVI). Twenty-six patients (4.4%) developed an ECF or an anastomotic leak. Thirteen (50%) patients underwent damage control laparotomy. Fistulas and leaks occurred in small bowel 13 (50%), large bowel 7 (26.9%), and duodenum 6 (23.1%). Five patients with ECF spontaneously resolved with medical treatment. Six patients (42.9%) with ECF were managed in the intestinal failure unit and required surgical intervention. Five anastomotic leaks were addressed at early relook laparotomy, with a mortality rate of 58.3%.

Conclusion: The anastomotic leak/ECF rate in PAT in our centre is 4.4% and is associated with a high mortality of 30.8%.