EP1027 - Multidisciplinary Management of Enterocutaneous Fistula at the Philippine General Hospital

Purpose/Background: Enterocutaneous fistulas (ECFs) are associated with sepsis, malnutrition, psychological issues, and prolonged hospitalization, leading to increased healthcare costs and resource utilization. It is a complex clinical challenge requiring a multidisciplinary approach to optimize outcomes. Effective management focuses on sepsis control, correction of fluid and electrolyte imbalances, nutritional support, cost-effective wound care, and psychological and physical rehabilitation. These are essential to improve postoperative outcomes and quality of life among colorectal surgery patients in a tertiary referral setting.

Methods/Interventions: This is a descriptive, retrospective review of patients treated for complicated ECFs from January 2021 to September 2025. Demographic and clinical data were retrieved from medical records. Perioperative data included treatment modalities and ancillary procedures done after index ECF formation, hospital length of stay (LOS), readmissions, morbidity, and mortality.

Results/Outcomes: Data from 25 patients with ECFs were analyzed. The median age was 51 years (range, 23-79), with an almost equal distribution between male (52%) and female (48%) patients. Comorbidities included tuberculosis, hypertension, human immunodeficiency virus (HIV), and chronic cerebrovascular disease. Among those with an identified underlying primary bowel disease associated with the development of ECFs were colorectal malignancy (44%), gastrointestinal tuberculosis (38%), and inflammatory bowel disease (18%). Most fistulas (88%) were related to surgery, while 12% spontaneously occurred-all having an infectious etiology

Two patients underwent conservative management, not needing any surgical procedure, with infection control, institution of a nutritional plan, and advanced wound care strategies. Out of the 25 patients, 22 had at least one previous abdominal surgery before the detection of the ECF. An average of 3 (range, 1-17) procedures were noted to have been performed after fistula formation-some of these included bowel diversion/resection, peritoneal lavage and negative pressure wound therapy (NPWT) changes done in an operating room setting. The ancillary procedures performed were colonic stenting to bypass the fistula, application of endoscopic clips to close the defect, and percutaneous drainage of intraabdominal abscess. The surgical and ancillary procedures performed on 23 patients after index ECF formation are listed in Table 1.

The mean hospital LOS was 30 days (range, 3-116) for those who improved while the mean hospital LOS was 36 days (range, 8-104) for those who died. Nineteen patients required readmission, with 11 patients needing at least 2 reconfinements. Fifteen of the 25 patients (64%) had eventual closure of the fistula. The mean time to fistula closure was 6 months (range,1-8). The mortality rate in this series was 40%.

Conclusion/Discussion: This study underscores the complexity and high mortality rate associated with ECF, emphasizing the need for comprehensive management. Although surgical intervention and advanced wound therapy play a significant role, the overall management of ECF requires a multidisciplinary approach that also focuses on nutritional support and perioperative medical optimization. The high rates of readmission and prolonged hospital stay further reflect the substantial healthcare burden and negative impact on patient's overall quality of life.

Multidisciplinary Management of Enterocutaneous Fistula at the Philippine General Hospital
Table 1. Patient demographics and outcomes of management of patients with complicated enterocutaneous fistulas. PGH, January 2021 to September 2025