1 / 24

Makafui Seth C-J. K. Đayie ( MBChB ) CCTH

Management of Acute Intestinal Failure from Entero -Cutaneous Fistula in a Resource Deprived Environment. Makafui Seth C-J. K. Đayie ( MBChB ) CCTH. OUTLINE. Introduction Definition Classification The study Conclusion. Introduction.

heremon
Télécharger la présentation

Makafui Seth C-J. K. Đayie ( MBChB ) CCTH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Management of Acute Intestinal Failure from Entero-Cutaneous Fistula in a Resource Deprived Environment Makafui Seth C-J. K. Đayie (MBChB) CCTH

  2. OUTLINE • Introduction • Definition • Classification • The study • Conclusion

  3. Introduction • Intestinal failure is defined as the reduction in intestinal absorption so that micronutrients and/or water and electrolyte supplements are needed to maintain health and growth. • It is a clinical syndrome. • Route of supplementation1: oral, enteral, parenteral 1Nightingale JMD. Definition and classification of intestinal failure. In Intestinal failure 2001; pp. ix-x. London: Greenwich Medical Media Limited.

  4. Intestinal failure • Acute • Very common; 90% in perioperative period1 • Surgery is pivotal in its management; some resolve spontaneously • Type 1 and type 2 • Chronic 1Nightingale JMD. Definition and classification of intestinal failure. In Intestinal failure 2001; pp. ix-x. London: Greenwich Medical Media Limited.

  5. The study • Adopting simple yet effective and proven strategies to reduce severity of intestinal failure. • A prospective longitudinal descriptive study • Patients recruited from the Central Regional Hospital, Cape Coast • 18 month period from April 2010

  6. Data extent • Epidemiological profile • Underlying disease • Nature of the primary operation • Number of operations • Number and nature of fistulae • Wound care technique • Mode of nutrition employed • Nature and dosage of drug therapy to slow bowel transit • Serial weight and serum albumin measurements

  7. Results

  8. Each patient had at least one laparotomy at the referring centre before laparostomy(median=2; range=1-3). • One case was nursed a the ICU; had the most surgeries done (7). • Dressings were done on the ward under sedation.

  9. Patient care • Decision to proceed to the initial laparotomy after the diagnosis of entero-cutaneous fistula was made largely on clinical grounds. • Contrast enhanced CT scan not available • Procedures • Diverting loop ileostomy • Proximal end stoma with distal mucus fistula + peritoneal lavage. • Abdominal wound care • Mass closure of the wound with loop PDS; skin unstitched • Bogota bag (1/4) • Entero-atmospheric sandwich dressing (2/3)

  10. Post operative fluid requirements • IV dextrose saline + ORS then free fluids; water deliberately avoided • High protein, high calorie low fibre diet

  11. Discussion • Multidisciplinary approach to management • Surgeon, nutritionist, dedicated ward nurses and counselors. • Control of sepsis • Soeters et al2 • laparotomy and lavage +/-ileostomy +/- mucus fistula • ?CT scan + drainage • Obviating need for repeated surgeries. 2Soeters PB, Ebeid AM, Fischer JE. Review of 404 patients with gastrointestinal fistulas. Impact of parenteral nutrition. Ann Surg 1979; 190: 189-202.

  12. Nutritional care • Fistulae +/- surgery affected distal ileum • Positive water and sodium balance was achieved; no need for parenteral nutrition (particularly total parenteral nutrition) • Had Plumpy’Nut (nutritional value as F-100; 2100kJ) • Daily egg consumption • Monitoring: • Weekly weight • 2x monthly Hb

  13. Wound care (mass closure)

  14. Wound care with Bogota bag

  15. Enteroatmospheric sandwich dressing

  16. Decreasing effluent from high output fistulae • Avoiding oral administration of water3, 4, 5 • Loperamide use • Use of codeine phosphate *octreotide 3Newton CR, Gonvers JJ, McIntyre PB, Preston DM, Lennard-Jones JE. Effect of different drinks on fluid and electrolyte losses from a jejunostomy. Journal of the Royal Society of Medicine 1985; 78, 27-34. 4Rodrigues CA, Lennard-Jones JE, Thompson DG, Farthing MJG. What is the ideal sodium concentration of oral rehydration solutions for short bowel patients? Clinical Science 1989; 74, Suppl. 18, 69. 5Nightingale JMD, Lennard-Jones JE, Walker ER, Farthing MG. Oral salts supplements to compensate for jejunostomy losses: comparison of sodium chloride capsules, glucose electrolyte solution and glucose polymer electrolyte solution (Maxijul). Gut 1993b; 33, 759-761

  17. Delineating fistula anatomy • Definitive management • Restoration of bowel continuity

  18. Conclusion • A structured multidisciplinary approach and cheaper innovations are readily available in resource deprived regions to ensure improved morbidity and mortality outcomes.

  19. Thank you!

More Related