RESUMO
Gastrointestinal cutaneous fistula G.I.C.F. occur either postoperative or spontaneous, it is a major complication to patients and surgeons together, still have significant incidence of morbidity and mortality. and it needs specific management. To study the causes of the fistula, to study the methods of treatment either medical or surgical with or without the use of total parenteral nutrition T.P.N. A prospective study done on 61 patients, divided into male and female, patients:, G.I.C.F. were divided into high output and low output fistulae, then an attempt to find the causes of the fistulae and the type of treatment both conservative and surgical treatment, also to study the effect of the use of T.P.N. 45 patients were male and 16 were female. Age range 13-58 years. The most common cause of the fistula was missile injury 39 [63.93%] patients, followed by iatrogenic 6 [9.83%] then carcinoma of colon 6 [9.83%]. 59 [96.72%] patients developed fistula postoperative, and only 2 [3.27%] patients developed the fistula spontaneous. The most common site of the fistula was the ileum 22 [30.06%] patients; the least common site was the esophagus 2 [3.27%]. 32 [52.45%] patients were with high output fistula. 29 [47.54%] patients were with low output fistula. Spontaneous closure rate was 57.37%, total number of patients treated by conservative methods were39, while the total number of patients treated by surgery were 22. 89.74% closure rate by conservative treatment, closure rate by surgical treatment were 63.63%. The mortality rate was 12 [19.67%] patients. Spontaneous closure rate of the fistula is high, the conservative treatment gave higher closure rate than the surgical treatment. The use of T.P.N. and octreotide decrease the morbidity and mortality