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FISTULA ENTEROCUTANEA
JOSE DOMINGO DIAZ NAJERARESIDENTE CIRUGIA GENERAL UNIVERSIDAD DE
CARTAGENA
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FISTULA
• ETIMOLOGICAMENTE : LATIN ... TUBO, CAÑERIA O CALAMO.
WIKIPEDIA.COM
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HISTORIA
• ALEX ST MARTIN 1822
Surg Clin N Am 91 (2011) 481–491
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HISTORIA
• BOHRER AND MILLER....” CHEMICAL BALANCE” 1931
• CHAPMAN 1965..... 4 KEY PRINCIPLES : FLUID, SKIN, ABSC , EFLUEN.
• 1969...... DUDRICK INTRODUCE LA NPT
http://www.chapmanmedicalcenter.com/default
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FISTULA• DEFINICION : COMUNICACION
ANORMAL ENTRE 2 TEJIDOS EPITELIZADOS.
MAINGOT`S ABDOMINAL OPERATIONS 11EDITION MC GRAW HILLS
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EPIDEMIOLOGIA
• 75 a 90% COMP POST OP.
• 0.8 - 2% CX ABDOMINAL TOTAL
• 5-20 % MORT. ANTES 43%
Surg Clin N Am 91 (2011) 481–491
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CLASIFICACION
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MAINGOT´S ABDOMINAL OPERATIONS 12 ED MC GRAW HILL
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CAUSAS
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LOCALIZACION
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VARIABLES • ANATOMIA : ORIGEN , DESCARGA Y
TRAYECTO.
WWW.GOOGLE.COM/IMAGES
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FISIOPATOLOGIA
MALNUTRICION
SEPSIS Na,K,Cl
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MAINGOT´S ABDOMINAL OPERATIONS 12 ED MC GRAW HILL
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F.R.I.E.N.D
MEDSCAPE Author: Vikram Kate, MBBS, MS, PhD, FRCS, FRCS(Edin), FRCS(Glasg), MAMS, FIMSA, MASCRS, FACS, FACG; Chief Editor: John Geibel, MD, DSc, MA more 2013
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EVALUACION Y MANEJO
• RECUENTO LEUCOCITARIO
• ELECTROLITOS
• PROTEINEMIA
• NIVELES DE TRANSFERRINA (< 200 MG/DL)
• PCR
LABORATORIOS
MEDSCAPE Author: Vikram Kate, MBBS, MS, PhD, FRCS, FRCS(Edin), FRCS(Glasg), MAMS, FIMSA, MASCRS, FACS, FACG; Chief Editor: John Geibel, MD, DSc, MA more 2013
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FISTULOGRAFIA
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FISTULOGRAFIA
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M.R.I
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MANEJO
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MANEJO
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TERAPIA CONSERVADORA
• REHIDRATACION
• ANTIBIOTICOS
• CORRECCION DE ANEMIA
• SOPORTE NUTRICIONAL
• CORREC DE ELECTROLITOS
• PROTECCION DE LA PIEL.
• CONTROL DRENAJE
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EVALUACION DE DRENAJE
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TRAUMA
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MANEJO MEDICO
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MANEJO DE CATETERES QUIRURGICOS
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TECNICAS
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STENT END.
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V.A.C ENDOSCOPICO
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ENDOBARIAL
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CLIPS
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V.A.C
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V.A.C
YOUTUBE.COM
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SIVACO
WWW.GOOGLE.COM/IMAGES
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CUSJD MARZO 2013
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CUSJD MARZO 2013
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CUSJD MARZO 2013
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CUSJD MARZO 2013
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CUSJD MARZO 2013
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CUSJD MARZO 2013
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CUSJD MARZO 2013
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MODIFICACIONES
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TIEMPO DE CIRUGIA
?
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NUTRICION
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NUTRICION
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FISTULOCLISIS
ISUP.COM
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CONCLUSIONES
• INDIVIDUALIZAR PTE
• NUTRICION FACTOR COMPROBADO
• PREFERIR MANEJO ENDOSCOPICO
• ENDOVAC
• EVITAR FISTULA SIENDO CUIDADOSOS
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http://josediazmd.blogspot.com
ESTA Y OTRAS PRESENTACIONES DE CIRUGIA GENERAL EN...
JOSE DOMINGO DIAZ NAJERA
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FIN
BENEDICT LIVES!!!