Case List History Objectives Radiology Images Questions SMALL INTESTINE AND APPENDIX Case #8 - A 55 year old man with wound drainage 6 days postop DISCUSSION QUESTIONS: 8.) What factors may cause this fistula to persist rather than closing spontaneously? Fistulas may not close spontaneously for the following reasons: a. Distal obstruction b. Presence of a foreign body c. Malignancy d. Undrained associated abscess e. Radiation enteritis f. Underlying inflammatory process in that segment (eg. Crohn’s) g. Epithelialization of the tract h. High output of the fistula i. Severe disruption of bowel - >50% of circumference j. A short fistula tract <2.5 cm. Therefore effort should be made to rule out any of these factors.
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