Management and Outcome of Enterocutanous Fistula in an Urban Centre in Nigeria

66 patients admitted into Enugu State University Teaching Hospital (ESUTH) with enterocutanous fistula between January 1998 and December 2008 (a ten year period) was reviewed retrospectively. 45 (68%) of the patients were females and 21 (31.8%) were males. The ages ranged from 3years to 68 years with peak age-range of 30-39 years. 30 (45.5%) followed laparatomy for ileal typhoid perforation, 15 (22.7%) followed laparatomy for intestinal obstruction and of this 8 cases (12.1%) were for intestinal obstruction secondary to colonic malignancies. 7 (10.9%) followed laparatomy for penetrating abdominal injuries, 6 (9.1%) followed post-appendicectomy,4(6.1%) followed laparatomy for TB abdomen that mimicked intestinal obstructions or peritonitis clinically,2 (3%) followed laparatomy for perforated duodenal ulcer and 2 (3%) followed traditional healers incision into an inguinal and a femoral hernia. 53 (80.3%) cases were referred from peripherial hospitals. 11 (16.7%) followed laparatomies done in our hospital mostly by surgical residents, while 2 (3%) were admitted into our hospital following traditional healers’ incision into an inguinal and a femoral hernia. 45.5% of patients had high output fistula, 28.8% had moderate output fistula and 25.7% had low output fistula. 49 (74.2%) of patients healed spontaneously on conservative management, 5 (7.6%) died during the resuscitation period. 12 (18.2%) required surgical intervention 4 (6.1%) died following surgical intervention, giving an overall mortality of 13.7%. The hospital stay ranged from 14 to 160 days with average hospital stay 92 days. The main cause of enterocutanous fistula in our environment was post-operative, accounting for 64 (97%) with laparatomy for ileal typhoid perforation alone accounting for 45.5% of the cases.