Pioderma gangrenoso y fístulas enterocutáneas tras anastomosis ileoanal con reservorioGangrenous pyoderma and enterocutaneous fistulas after ileal. Introducción: la baja prevalencia de las fístulas enterocutáneas (FEC) en los pacientes con enfermedad de Crohn (EC) justifica la escasez de. Necesidad de formar unidades funcionales especializadas en el manejo médico- quirúrgico de pacientes con fístulas enterocutáneas y fracaso intestinal.

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Fortunately, surgeons rarely must afford such difficult problem. The results of these studies will help us learn the true efficacy of biological therapies in these patients 9.

Dig Surg ; Management of intestinal fistulas. Logistic regression test did not show meaningful results in fistuals variable probably due to the low number of events deaths recorded in the sample. While it is true that these patients require frequent decision-taking during treatment, surgery as initial indication is a major issue. Treatment of high-output enterocutaneous fistulas with a vacuum-compaction device.

A Systematic review of the benefit of total parenteral nutrition in the management of enterocutaneous fistulas. Lastly, 49 patients Moreover, some recent publications have suggested, after observing certain complications that may be related to the method, taking caution in the application of negative pressure therapy [17] – [18].

Sepsis, multiple lesions and abdominal wall defect were negatives prognoses factors. Int J Colorectal Dis ; Seventy six cases initially presented sepsis The objective of this study was to evaluate the clinical characteristics of patients with CD who have ECF and the response to different treatments. The direct causes were suture line or intestinal anastomosis disruption in 56 patients In addition, the disease phenotype was determined using the Montreal Classification and the level of disease activity was based on the Harvey-Bradshaw index.


Variables were faced with the mortality event using program SPSS version Therefore, this may be a treatment strategy prior to surgery in a select group of patients. After reaching stability, 32 patients continued treatment at home.

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Therefore, neither medical nor surgical treatments have shown a high percentage of ECF closure. It could therefore be considered as a treatment strategy prior enterocuatneas surgery in a select group of patients.

Table I shows the patients’ clinical and demographic characteristics. The following treatments were considered: A management protocol by stages was applied.

Surgical management of entero and colocutaneous fistulae in Crohn’s disease: This proposal was the basis of modern approach of this pathology. Consequently, the following benefits have been previously described and were thus confirmed in our experience: Complete resolution of enterocolic fistulas with infliximab.

Fourteen out of fistulized patients were initially operated, 4 of them electively, while surgery for peritonitis was indicated in the remaining Worl J Surg ; Forty-six presented sepsis during conservative treatment, mainly due to catheter contamination and respiratory disease. The majority of these close spontaneously or enterocutanes skin care, antibiotics and fluids.

Aspiration methods and octreotide were implemented as alternative or complementary options.


Diagnosis was made after physical examination and a computed tomography CT or magnetic resonance MRI study. Regarding the patients’ clinical characteristics, epidemiological factors such as year of diagnosis, presence of a family history of inflammatory bowel disease, tobacco use, and the presence of extraintestinal manifestations were recorded. Initial surgery is a valid option in patients maintaining a good general condition and is a necessity in cases where the fistula coexists with acute abdomen.


Our study revealed that in patients who had associated perianal disease, ECF response to anti-TNF treatment correlated with the response in perianal disease. J Crohns Colitis ;4: A systematized management of ECF allows to optimizing treatment results. Type of fistula determines response to infliximab in patients with fistulous Crohn’s disease. Depending on the type of fistula, anti-TNF treatment led to closure of the fistula in 1 of 14 spontaneous fistulas and 2 of 10 postoperative fistulas.

First, it should be pointed out that fistula closure has been achieved in some cases, after this time period, with the assistance of innovative treatments, such as sub-atmospheric pressure [2] – [6].

Despite the known limitations of this type of study, we can conclude that although the majority of patients required surgery as the definitive treatment, anti-TNF drugs improved fistula output in an acceptable percentage of patients.

When we began our experience, we observed that, in said protocols, the aims to be achieved were mixed in different stages, some terms were not clearly defined and mainly, they did not represent faithfully enteroutaneas current conduct.

The low response rate in our study was notable, both for spontaneous and postoperative ECF when treated with antibiotics British Journal of Surgery ;81,