Several focus issues and countermeasures in the diagnosis and treatment of intestinal fistula

WANG Ge-fei; WU Lei; REN Jian-an

doi:10.19538/j.cjps.issn1005-2208.2025.03.06

Abstract：Enterocutaneous fistula is a common complication following gastrointestinal surgery,with a high mortality rate.Its occurrence typically results from the leakage of digestive fluids,leading to intra-abdominal infections,sepsis,multiple organ failure,and other severe complications.The pathophysiological characteristics of enterocutaneous fistula are closely related to its treatment.Based on different pathophysiological changes,enterocutaneous fistula can be classified into critical and stable types.Critical enterocutaneous fistulas typically occur in the early stages of the disease and have a higher mortality rate,while stable enterocutaneous fistulas refer to those in which the condition has been initially controlled,primarily facing issues such as fluid loss.The occurrence of enterocutaneous fistula can also trigger a series of complications,including increased intra-abdominal pressure,pulmonary infections,and renal failure.Early detection is crucial for the diagnosis of enterocutaneous fistula.Direct signs,such as the leakage of digestive fluids and changes in symptoms of intra-abdominal infection,as well as indirect signs like digestive enzyme corrosion,can all serve as diagnostic criteria.The timeliness of diagnosis plays a decisive role in formulating an effective treatment plan,which can significantly reduce the mortality rate.With the continuous advancement of endoscopic technology,treatment methods for enterocutaneous fistula have become more diverse.New techniques,such as endoscopic negative pressure therapy and mucosal debridement,provide more possibilities for the self-healing of the fistula.In terms of treatment,the management of enterocutaneous fistulas requires a staged approach.In the critical phase,the primary goal should be lifesaving,utilizing comprehensive measures such as fluid management,anti-infection therapy,and infection source control.As the condition stabilizes,the focus of treatment shifts to promote self-healing,reduce the need for surgical intervention,and provide nutritional support and pre-rehabilitation therapy.Although staged treatment strategies have shown preliminary success in practice,the treatment of enterocutaneous fistulas still faces many challenges,particularly in terms of personalized treatment and long-term management.Future research should further explore the pathophysiological characteristics of enterocutaneous fistulas and optimize treatment plans to achieve higher cure rates and better patient outcomes.