ENTEROCUTANEOUS HIGH OUTPUT FISTULAE

OCTREOTIDE AN EFFECTIVE TOOL IN MANAGEMENT

Abstract

Enterocutaneous fistula is an abnormal communication between epithelial lined lumen of GI tract & epithelium of an adjacent viscous or skin. Objectives: To find out role of octreotide in the management of high enterocutaneous fistula. Design: Case study. Setting: Department of Surgery Unit-II Punjab Medical College & A & E Department of Jinnah Hospital /AIMC Lahore. Period: From Jan 2007 to Dec 2008. Patients & Methods: 479 laparotomies were carried out due to trauma. Out of these 21 i.e. 4.38% developed high out put enterocutaneous fistula. All patients were put on similar conservative management including, TPN, antibiotics, fluid electrolyte replacement and stoma care. Results: Patients were split into two groups alternatively. There were no statistical difference between the study groups with regard to the age (p-value=0.515). Group I contains 11 patients (octreotide) received additionally 100mg octreotide S/C 8 hourly, showed decrease of volume from 680 to 150ml within 10 days. Spontaneous closure was observed in 8(72.72%) patient & surgery was required in 2(18.18%) patients. Death was 1(9.09%). In Group II remaining 10 patients(without octreotide), fistula discharge volume decreased form 650mg to 150ml in 20 days. Spontaneous closure was noted in 5(50%) cases. Surgery was required in 3(30%), while death rate was 2(20%).Conclusions: It is concluded that Octreotide, an analogue of somatostatin with longer half life is effective in treatment of high output fistula.