Management considerations are:

• Resuscitation and fluid and electrolytes imbalance

• Nutritional support

• Medical treatment (antibiotics, octreotide, H2 blockers)

• Skin protection

• Surgery and its timing

Initially adequate fluid and electrolyte administration is necessary to correct dehydration, achieve hemodynamic stability and maintain renal function. Skin is protected by the dual use of stoma bag and stoma adhesive / Karaya paste / zinc peroxide paste. The stoma bag allows measurement of fluid losses and, to an extent, the electrolytes and hence better maintenance of fluid and electrolyte balance. It also provides a measure of the response to therapy.

Fistulae through drainage tube sites and which are away from (a) main wound, (b) scars of previous surgery, (c) umbilicus, (d) bony prominences and accept the stoma bag snugly. In situations where a stoma appliance will not function properly, ingenuity of clinician and of the stoma nurse as well as versatility of appliance are necessary. Placement of DuoDerm around the fistula with red rubber catheters irrigating and draining the area are also useful.

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