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Behandlung enteraler Fisteln beim offenen Abdomen

Treatment of enteric fistula in open abdomen

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Zusammenfassung

Die Entstehung enteraler Fisteln ist eine häufige Komplikation nach Abdominaltraumata. Unter den enterokutanen Fisteln haben die posttraumatischen Fisteln die beste Prognose. Zur Optimierung der Abheilung ist ein ganzheitliches Vorgehen erforderlich. Der Sepsisfokus muss frühzeitig beherrscht sein, zum Schutz der Bauchdecken sind spezielle Wundbehandlungssysteme erforderlich, und die Ernährung ist optimal einzustellen. Die Ursache der Fistel, ihre klinische Abheilungstendenz und ihre Sekretzusammensetzung können hinweisend für die Möglichkeit einer Spontanheilung sein. Eine definitive operative Therapie kann notwendig werden, um eine persistierende Fistel wie auch die Bauchwand definitiv zu verschließen. Der anschließende Kostaufbau wird durch die körperliche und berufliche Rehabilitation ergänzt.

Abstract

Formation of enteric fistulas frequently complicates the open abdomen in patients who have sustained traumatic injury. The post-traumatic subset of patients with enterocutaneous fistula enjoy better than average recovery. To optimize this recovery, a systematic management approach is required. Patients must first be stabilized with nutritional support, control of sepsis, and special wound management systems to prevent further deterioration of the abdominal wall. Investigation of the origin, course, and characteristics of the fistula provides information about its likelihood to close without operation. Definitive operative therapy may be necessary to resolve the fistula and close the abdominal wall. Finally, healing support includes nutritional support and physical and occupational therapies to restore patients to pre-injury states.

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    R. A. Evenson &  J. E. Fischer

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  1. R. A. Evenson
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  2. J. E. Fischer
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Correspondence to J. E. Fischer.

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Übersetzt von PD Dr. C. Schumacher, Chirurgische Klinik der TU München, Klinikum rechts der Isar

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Evenson, R.A., Fischer, J.E. Behandlung enteraler Fisteln beim offenen Abdomen. Chirurg 77, 594–601 (2006). https://doi.org/10.1007/s00104-006-1207-2

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