Fístula Enterocutánea Secundaria a Apendicectomía

Abstract

It is defined as enterocutaneous fistula (FEC) to the existing pathological communication of a portion of the gastrointestinal tract into the skin. As an important complication of gastroenterological surgery, 75-90% of fistulas is presented as a postoperative complication in most cases, with an incidence of 0.8-2% in abdominal surgery.1-4-11 The development of an enterocutaneous fistula is a serious problem that can face any surgeon during the exercise of their profession, bringing physical and emotional repercussions for both the patient and family and physician and health institution where it is. 3-4-10 They are associated with high morbidity and mortality forcing a prolonged hospital stay, complications and electrolyte mainly as sepsis, malnutrition and metabolic imbalance.1-2-9 Therefore it requires a multidisciplinary intervention adapted by each particular case.3-4 Increased life expectancy and the advancement of surgery in the treatment of increasingly complex conditions, should contribute in the near future, to a considerable increase in their frequency. It is attributed to enterocutaneous fistulas mortality 15-37%, which rises further and can exceed 60% when associated to complications and mencionadas.4-12 Reviewing the case of a 29-year-old it was held intervened on January 26, 2016 in the Yerovi Mackuart Hospital of Salcedo, which comes because of abdominal pain, cramping, high intensity, about 5 hours evolution, located in mesogastrio and lower abdomen, accompanied by nausea that comes vomiting for 5 times, in which complementary studies is done reaching a diagnosis of acute appendicitis, surgery is decided by performing an exploratory laparotomy and found multiple perforations in cecum and colon with mesenteric thrombosis signs so appendectomy is performed more right hemicolectomy more lateral anastomosis term transverse loop ileostomy ileus more drainage and placement; it remains hospitalized for eight days, start to have purulent liquid drainage site, so it was decided to transfer to Provincial General Hospital in Latacunga on February 4, 2016 with a diagnosis of enterocutaneous fistula. Provincial General Hospital in Latacunga is received to the patient at the Department of General Surgery, it is decided to maintain hydration, antibiotic therapy, laboratory tests and imaging studies, which remains hospitalized for 21 days. Given patient is discharged with good performance and has surgery scheduled reentry, return of intestinal transit. The patient is progressing well from his second surgery without presenting complication, it is decided discharged on April 21, 2016. On April 24, 2016 was readmitted for an intestinal partial obstruction the same that resolves spontaneously and is discharged the May 2, 2016.