Enterocutaneous Fistula

An enterocutaneous fistula is a connection that shouldn’t exist between your gastrointestinal (GI) tract and your skin. It might allow fluids like bile and poop (stool) to escape your intestines and leak onto your skin. This makes it a type of external fistula because it leads outside your body. Certain diseases, injuries and treatments for other conditions can cause it.

“Fistula” refers to an abnormal tunnel between two areas. A fistula always needs medical attention. But an enterocutaneous fistula is serious because it can allow bacteria to make you very sick or lead to other problems. It can also rob your body of hydration and nutrients because your digestive organs can’t break them down very well.

Some fistulas close over time with the right treatment. In other cases, your healthcare provider may use surgery to remove the part of the intestine that connects to your skin.

Symptoms of an enterocutaneous fistula

An enterocutaneous fistula can cause many different symptoms depending on the type and how long it’s been there. These may include:

• Signs of infection under your skin, like redness, pain and unusual warmth
• An opening in your skin that leaks fluids, which can be painful

Enterocutaneous fistula causes

Typically, an enterocutaneous fistula forms after surgery on your GI tract. Certain diseases and conditions can also cause fistulas, like:

• Appendicitis
• Diverticulitis
• Cancer and cancer removal surgery
• Inflammatory bowel disease (IBD), like Crohn’s disease
• Trauma

Risk factors

Having a history of any of these conditions or treatments puts you at risk for an enterocutaneous fistula. Other important risk factors include:

• Smoking
• A history of radiation
• Malnutrition
• Having had an enterocutaneous fistula before

Complications of an enterocutaneous fistula

Without proper treatment, an enterocutaneous fistula can lead to an infection. This can be mild or even life-threatening (sepsis).

Fistulas can irritate your skin, which can range from uncomfortable to severe.

An enterocutaneous fistula can also cause your body to lose important nutrients it needs to stay healthy. This can lead to dehydration and malnutrition.

How doctors diagnose an enterocutaneous fistula

There are many different kinds of fistulas. So, your provider will use lab and imaging tests to confirm an enterocutaneous fistula diagnosis.

Lab tests look for certain cells, signs of inflammation and mineral levels in your blood. They include:

• Complete blood count (CBC)
• Electrolyte panel
• Nutrition studies

Imaging tests give your provider a better look at the fistula from the inside. They may use:

• CT scan
• X-rays with contrast
• Fistulogram

A fistulogram is especially designed for fistulas. It’s helpful when your provider wants specific details that other imaging isn’t giving them. But in some cases, it may be the only imaging test you need.

Your provider might order an upper endoscopy or colonoscopy, in some cases.

Usually, they’ll also physically examine the fistula with the help of a wound ostomy nurse.

How is an enterocutaneous fistula treated?

An enterocutaneous fistula is a complex condition. Depending on your specific situation, the fistula might close on its own with treatment, or it may need surgery to help it along.

Healthcare providers use the acronym “SNAP” to help them focus on what’s most important in your care.

SNAP stands for:

• Sepsis and skin care: Your provider will look for signs of infection. They’ll use antibiotics and, sometimes, drainage procedures to treat any problems they find. A wound ostomy nurse will also make sure the skin around the enterocutaneous fistula stays clean and healthy.
• Nutrition: The enterocutaneous fistula may cause your body to lose important nutrients. Depending on your situation, you may be able to eat normally or eat a special diet. But if that worsens the fistula, your provider may give you parenteral nutrition (through an IV).
• Anatomy: It’s important for your provider to know what the fistula looks like inside and out, as well as what’s happening around it. They’ll use imaging and, possibly, a physical exam to get a closer look.
• Plan or procedure: Once your provider manages the enterocutaneous fistula, they’ll develop a care plan to treat it in the long term. There are some cases where the fistula might heal on its own with the right nutrition and plenty of time. So, providers prefer to give it a chance to repair itself before they consider surgery. They might give you medications to promote this.

If the fistula is mild and doesn’t cause a lot of symptoms, you may not need further treatment.

Surgery

What happens during surgery will depend on your unique situation. But the aim is to close the fistula by removing the part of your intestine that’s unhealthy. Sometimes, this requires an ostomy to allow the newly connected intestines to heal.

Recovery time

Recovery time depends on the surgery you have. If you have questions about what to expect as your body heals, reach out to your provider.

When should I see my healthcare provider?

As you recover, let your healthcare provider know if you experience:

• Abdominal pain or discomfort
• Fever
• New leakage or infection near the wound site

This could signal that the enterocutaneous fistula is getting worse or returning.

What can I expect if I have an enterocutaneous fistula?

Your outlook depends on the cause of the fistula and any possible complications that follow. Some will close within a few months or so, either on their own or with treatment. If you need surgery, your provider will discuss next steps with you.