Enterocutaneous Fistula (ECF)

What is Enterocutaneous Fistula (ECF)

Enterocutaneous Fistula is the most common type of intestinal fistula.

An intestinal fistula is an abnormal connection (fistula) that can develop between the intestines and another part of your body. The most common type of intestinal fistula is called an enterocutaneous fistula.

It can cause fluid from the intestines to leak out through the skin. Most ECFs start in the small or large intestine then drain through the skin of the abdomen. They most often develop after abdomen (abdominal) surgery.

What are the causes of enterocutaneous fistula ?

An ECF is usually caused by surgery that involves the intestines. A leak may occur where an opening was made into the intestines and then closed, or it may occur if the intestines were punctured accidentally during surgery. Other causes of ECF include:

• An injury (trauma) to the abdomen.
• Radiation treatments on the abdomen.
• A perforated ulcer.
• An inflammatory bowel disease (IBD), such as Crohn disease.
• Infection from another condition that affects the intestines, such as appendicitis or diverticulitis.
• An incision into a tumor.
• Poor nutrition or not getting enough nutrients from food (malnutrition).

What are the signs or symptoms?

Common symptoms of this condition include:

• Drainage from an abdominal incision area or from an opening of the abdominal skin.
• Abdominal pain.
• Severe pain when pressing on the abdomen.
• Abdominal swelling.
• The abdomen feeling hard and looking bigger than normal (distended).
• Diarrhea.
• Fever.
• Rapid heartbeat.

How is this diagnosed?

This condition may be diagnosed based on:

• Your symptoms and your medical history. Your health care provider may suspect this condition if you have symptoms after abdominal surgery or if you have another risk factor for an ECF.
• A physical exam.
• Tests, such as:
  • Blood tests to check for infection and loss of blood minerals (electrolytes).
  • X-rays that are done after a type of dye (contrast) is put into the fistula or intestines.
  • Imaging studies such as a CT scan, ultrasound, or MRI.

How is this treated?

The usual goal of treatment is to help the fistula heal over time. You may start this medical treatment in the hospital. It may take several weeks of close and careful monitoring. Treatment may include:

• IV fluids to keep you hydrated and to replace the fluids and certain minerals (electrolytes)that your body needs.
• IV nutrition.
• Tube feeding.
• Antibiotic medicines given through an IV.
• A procedure to drain a sac of pus (abscess) that may have collected in the abdomen.
• Medicines to reduce stomach acid and secretions.
• Medicines that are placed inside the fistula to seal it.
• A bandage (dressing) or another form of skin protection.
• A pouch to collect the fluid may be put in place.

If the fistula does not close after a couple months, surgery may be done to close the fistula. You may be more likely to need surgery if you developed an ECF after having radiation, infection, or a tumor.

Follow these instructions at home:

Medicines

• Take your antibiotic medicine as told by your health care provider. Do notstop taking the antibiotic even if you start to feel better.
• Take over-the-counter and prescription medicines only as told by your health care provider.

Fistula care

• Follow instructions from your health care provider about how to take care of your fistula. Make sure you:
  • Wash your hands with soap and water before you change your dressings. If soap and water are not available, use hand sanitizer.
  • Change your dressings as told by your health care provider.
• Check your fistula site every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.

General instructions

• Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.
• Follow instructions from your health care provider about eating or drinking.
• Drink enough fluid to keep your urine pale yellow.
• If you are prescribed a skin protection or antibiotic ointment, apply it as told by your health care provider. Do notstop using the ointment even if your condition improves.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing. If you need help quitting, ask your health care provider.

Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have chills or a fever.
• You have redness, swelling, or pain around your fistula.
• Your fistula feels warm to the touch.
• You have pus or a bad smell coming from your fistula.
• You have more fluid or blood coming from your fistula area.
• Your fistula starts to drain more often or more heavily.
• You have persistent diarrhea.
• You are losing weight.
• Your pain medicine is not helping.

Get help right away if:

• You have severe abdominal pain.
• You have persistent bleeding from your fistula.
• You cannot eat or drink without vomiting.

Summary

• An intestinal fistula known as an ECF is an abnormal connection that develops between an area of your intestines and your skin.
• If you have an ECF, the contents of your intestines can leak out through your skin.
• An ECF is usually caused by surgery that involves the abdomen or intestines.
• Treatment for this condition usually starts with medical treatment to help the fistula heal over time.
• You may need surgery to close the fistula if it has not closed after a couple months.

Enterocutaneous Fistula Home Guide

An intestinal fistula is an abnormal connection (fistula) that can develop between the intestines and another part of your body. The most common type of intestinal fistula is called an enterocutaneous fistula (ECF). An ECF can cause fluid from your intestines to leak out through your skin.

Treatment usually starts in the hospital with the goal of helping the fistula heal over time. However, it may take weeks or months for your fistula to close completely. You may be sent home during this time, so your health care provider will teach you to care for your fistula at home. It may be helpful to train a family member as well.

At home, you will need to change your bandages (dressings) and take steps to care for your skin in the area of the fistula. Drainage from the fistula can be very damaging to your skin. A fistula that drains a lot of fluid usually requires some type of pouch system to collect the fluid. You may need to change the pouch. You may also need to use a skin barrier and apply ointment to protect your skin.

How to care for your fistula and skin

Your health care provider will give you specific instructions for caring for your fistula at home. Follow those instructions carefully. You may be given these general instructions:

• If you are prescribed a skin protection or antibiotic ointment, apply it as told by your health care provider. Do notstop using the ointment even if your condition improves.
• Make sure you wash your hands with soap and water before you change your pouch or dressing. If soap and water are not available, use hand sanitizer.
• Change your pouch or dressing as told by your health care provider.
• Check your fistula site every day for signs of infection or skin damage. Check for:
  • Redness, swelling, or pain.
  • More fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Do nottake baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

General instructions

• Take over-the-counter and prescription medicines only as told by your health care provider.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider.Do notstop taking the antibiotic even if you start to feel better.
• Follow instructions from your health care provider or dietitian about eating or drinking requirements or limits (restrictions). Good nutrition is important for healing.
• Drink enough fluid to keep your urine pale yellow.
• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. These can delay healing. If you need help quitting, ask your health care provider.

Keep all follow-up visits as told by your health care provider. This is important.

Contact a health care provider if:

• You have chills or a fever.
• You have redness, swelling, or pain around your fistula.
• You have more fluid or blood coming from your fistula.
• Your fistula area feels warm to the touch.
• You have pus or a bad smell coming from your fistula.
• You have increased drainage from your fistula.
• Your drainage pouch leaks.
• You have persistent diarrhea.
• You are losing weight.

Get help right away if:

• You have severe abdomen (abdominal) pain.
• You cannot eat or drink without vomiting.
• You have heavy drainage or bleeding from your fistula.

Summary

• It may take weeks or months for your fistula to close completely. Follow instructions from your health care provider about how to take care of your fistula at home.
• Take antibiotics or use skin ointments as told by your health care provider.
• Check your fistula site every day for signs of infection or skin damage.
• Contact your health care provider if you have chills, fever, pain, signs of skin infection, or problems with your drainage pouch.