Clinical Challenges in Colorectal Surgery: Management of Enterocutaneous Fistulas

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 6 January 2025

⏱️ 39 minutes

🔗️ Recording | iTunes | RSS

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Summary

Join Drs. Galandiuk, Bolshinsky, Kavalukas, and Simon as they discuss non-operative and operative management of enterocutaneous fistula. Come with us as we navigate through tips and tricks for preventing and managing enterocutaneous fistulas!

Hosts:
- Susan Galandiuk, University of Louisville, Louisville, Kentucky, @DCREdInChief
- Vladimir Bolshinsky, Peninsula Health, Victoria, Australia, @bolshinskyv
- Sandy Kavalukas, University of Louisville, Louisville, Kentucky, @sandykava
- Hillary Simon, University of Louisville, Louisville, Kentucky, @HillaryLSimon

Producer:
- Manasa Sunkara MS4, University of Louisville, Louisville, Kentucky, @manasasunkara12

Learning objectives:
- Review causes of enterocutaneous (EC) fistulas.
- Understand EC fistula prevention and management tenets.
- Discuss surgical tips and tricks for tackling EC fistulas.

References:
- Ellison EC, Upchurch GR, et al. Fischer’s Mastery of Surgery. 8th ed, Vol 1. Philadelphia, PA: Wolters Kluwer; 2024:1175-1182.
- Fazio VW, et al. Current Therapy in Colon and Rectal Surgery. 8th ed. Philadelphia, PA: Elsevier; 2017:404-411.
- Mulholland MW, et al. Operative Techniques in Surgery. Vol 2. Philadelphia, PA: Wolters Kluwer; 2015:934-942.
- Steele SR, et al. Illustrated Tips and Tricks in Colon and Rectal Surgery. Philadelphia, PA: Wolters Kluwer; 2021:263-269.

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Transcript

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0:00.0	Behind the Knife, the Surgery Podcast, relevant and engaging content designed to help you
0:11.6	dominate the day.
0:24.1	Welcome back Behind the knife listeners.
0:30.6	Today I have my team, Dr. Cavalukas, Walshinsky, and Glandiac with me to go through several case scenarios surrounding the prevention and management of enterocutaneous fistulas.
0:35.6	To review an anterioricutaneous or EC, fistula, is an abnormal connection between the gastrointestinal
0:43.0	tract and skin.
0:45.0	Considering most EC fistula's result from surgery, this is a dreaded complication and a
0:49.6	postoperative issue common to most surgeons.
0:52.8	Today we'll focus discussion on prevention and management
0:55.4	of post-operative EC fistulas. Let's use a complicated case to highlight important tips and tricks.
1:02.6	All right, so let's say that you have a 64-year-old man who presented to the hospital and you did
1:08.3	a urgent small bowel obstruction due to a closed loop
1:12.4	stricter or closed loop obstruction in the setting of prior radiation that the patient
1:17.3	had maybe gotten 10 years ago. So you see him back in clinic. It's his two-week follow-up
1:22.3	and he says he's now doing so hot. He has some fevers, chills, and abdominal pain. And when you look
1:28.7	at his abdominal exam, he has some erythema, swelling, and tenderness over his abdominal wall.
1:35.2	So you're concerned and you admit the patient to the hospital which will further work out.
1:39.8	So Dr. Bolshinsky, it's two weeks out. What do you think, are you, do you think this guy should go back to the OR or what kind of
1:46.9	things, how do you think you're going to manage this patient?
1:49.8	Yes, this is a incredibly challenging problem that all abdominal visceral surgeons face,
1:57.0	not only colorectal surgeons.
1:58.5	I certainly tell many trainees, and that was what I've been
	...

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