Editing Enterocutaneous fistula (section)

=== '''Stabilisation / initial medical treatment''' ===

#* Resus + antibiotics - halt      catabolism
#** Aggressive fluid therapy
#** Cease antibiotics 5-7 days       after source control has been obtained and sepsis has resolved.
#** Antibiotics in non-septic       patients with ECF is controversial, and there is no evidence of improved       outcomes, so probably shouldn't be done routinely.
#* CT. If evidence of free GIT      perforation or diffuse peritonitis, need urgent exploration. Focus on      infection drainage and exteriorisation of any leaking bowel. Don't redo      the anastomosis in the infected field in order to create a stoma, but you      could divert the faecal stream higher up.
#* Infected wounds, abscesses,      etc are opened and drained. Perc drainage of intra-abdo collections      (allows changing a complex fistula to a simple one) - generally done      through anterior abdominal wall, but can be done transgastric/transrectal      etc.
#* Fix electrolytes
#* Involve MDT - consistent      messaging
#* Set realistic expectations      with patient and family