Percutaneous Drainage

Ultrasound guided drainage or CT scan should be carried out to rule out local collections or abscesses. If found these should be aspirated or therapeutically drained by a pigtail catheter through a window devoid of bowel and vital structures. A complete microbiological examination of the fluid is essential. Technical inability to drain such a collection or an abscess is an indication for early surgery.

Nutritional support is the single most important therapy which in recent times has contributed to a decrease in morbidity/mortality and even led to spontaneous closure of many low output and some moderate output fistulae. It is started only after achieving hemodynamic stability and normalization of electrolytes and renal status. Higher the fistula in the intestinal tract lesser is the tolerance and effectiveness of enteral nutrition. Even if the nutritional support does not heal the fistula, it does decrease the fistulous effluent, minimizes local infection, and increases tissue integrity. All these ensure a better outcome of the reparative operation. Patients with a serum albumin of less than 2.5 g/dL have a mortality of 64% and spontaneous closure of only 23%.

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