Pioderma gangrenoso y fístulas enterocutáneas tras anastomosis ileoanal con reservorioGangrenous pyoderma and enterocutaneous fistulas after ileal. Introducción: la baja prevalencia de las fístulas enterocutáneas (FEC) en los pacientes con enfermedad de Crohn (EC) justifica la escasez de. Necesidad de formar unidades funcionales especializadas en el manejo médico- quirúrgico de pacientes con fístulas enterocutáneas y fracaso intestinal.

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The data obtained in our study were obtained from a retrospective series. Ninety-six pecent of patients received antibiotics metronidazole and ciprofloxacinwith non-response rates of Regarding the patients’ clinical characteristics, epidemiological factors such as year of diagnosis, presence of a family history of inflammatory bowel disease, tobacco use, and the presence of extraintestinal manifestations were recorded. Fistulas are a very common and significant complication in Crohn’s disease CD.

New methods have been proposed in order to block intestinal flow: Meanwhile, 1 patient did not receive previous biological treatment and was treated with adalimumab for a mean duration of 16 months. Am Surg ; Most frequent primary pathologies were colorectal neoplasia, diverticulitis, abdominal trauma, appendicitis and hernia, of which 62 There has even been a case described of an ECF that resolved with infliximab in a patient who did not have CD 8.

Clinical signs of ECF were described as the passage of gas or feces through an external orifice as well as the presence of abdominal pain. Variables were faced with the mortality event using program SPSS version After the first, second and third dose, patients described symptomatic improvement and had no output from the fistula after the eighth dose.

A systematized management of ECF allows to optimizing treatment results.

A total of 24 patients were treated with anti-TNF. The accumulated experience throughout these years has allowed us to optimize the treatment improving in fistulas spontaneous closure and mainly obtaining a substantial mortality ifstulas decrease.

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Management of external small bowel fistulae: First, it should be pointed out that fistula closure has been achieved in some cases, after this time period, with the assistance of innovative treatments, such as sub-atmospheric pressure [2] – [6]. While it is true that these patients require frequent decision-taking during treatment, surgery as initial indication is a major issue.

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There is currently no controlled study that analyzes ECF response to treatment, so we cannot make any comparison with previously-published studies in this section. However, it is possible that many other factors should significantly impact fistulized patient outcomes.

British Journal of Surgery ;81, The results of these studies will help us learn the true efficacy of biological therapies in these patients 9. Forty-six presented sepsis during conservative treatment, mainly due to catheter contamination and respiratory disease. Analysis of the level of association was made using Fisher’s exact test, the Kappa index and the Wilcoxon test. Although some, at first, showed encouraging results, they have failed to prove their enyerocutaneas effectiveness as most of the published series make fistuls to a few patients, usually of deep and low output fistulas, which generally heal whichever conservative treatment.

Fistulas – Fistulas Enterocutaneas – Dr. Daniel Wainstein

Treatment of high-output enterocutaneous fistulas with a vacuum-compaction device. Rev Esp Enferm Dig ; Despite the known limitations of this type of study, we can conclude that although the majority of patients required surgery as the definitive treatment, anti-TNF drugs improved fistula output in an acceptable percentage of patients. This proposal was the basis of modern approach of this pathology.

Global healing was possible in patients of the series All patients with a documented history eenterocutaneas CD who developed an ECF during their clinical progress from to were included retrospectively. Demographic aspects, fistula’s characteristics and conservative treatment modality were evaluated.

The right timing to complete conservative treatment and proceed with surgical repair remains controversial. Initial surgery is a valid option in patients maintaining a good general condition and is a necessity in cases where the fistula coexists with acute abdomen.

Other studies have also identified the following negative factors: We used for these proceedings, an own digital and portable equipment designed specifically for treatment of enterocutaneous fistulas. Combined approach with biologics and surgery for enterocutaneous fistulas in Crohn’s disease.


Then, after controlling intestinal effluent, the parenteral route is gradually replaced by the enteral one, if it is well tolerated and does not complicate wound management. Therefore, this may be a treatment strategy prior to surgery in a select group of patients.

Controlled studies are needed in order to evaluate the efficacy of the different medical and surgical treatments available in patients with ECF. The definitions of partial or complete response were based on the fistjlas physician’s judgment.

Diagnosis was made after physical examination and a computed tomography CT or magnetic resonance MRI study. Demographics, patient characteristics fisutlas injury aspects were recorded.


When enterocutanea began our experience, we observed that, in said protocols, the aims to be achieved were mixed in different stages, some terms were not clearly defined and mainly, they did not represent faithfully our current conduct. Arch Surg ; 6: Sepsis treatment and hidroelectrolite balance restoration do not differ substantially from that applied in the routine management of critically ill patients so that it will not be analyzed in this presentation.

Introduction Fistulas are a very common and significant complication in Crohn’s disease CD. Consequently, the following benefits have been previously described and were thus confirmed in our experience: Ileocolonoscopy revealed disease recurrence at this level so treatment with anti-TNF was started. J Am Coll Surg ; 4: In recent years, enthusiasm has waned because it could be seen that, while it is effective to reduce enteric output, and even to accelerate some fistulas closure time, it has not been possible to demonstrate a rise in percentage of spontaneous closure or a fall in mortality enterocutanras.

Am J Surg ; 1: In these cases, the decision to treat medically or surgically should be evaluated on an individual basis according to the factors mentioned above. Octreotide, a synthetic somatostatine analogueis a powerful inhibitor of gastrointestinal biliary and pancreatic secretions.