Postoperative digestive fistulas in children

Introduction: Postoperative gastrointestinal fistula (POF) is a dreaded complication of abdominal surgery because it can be life-threatening. Conservative management is a challenge. The objectives were to describe the epidemiological, etiology, anatomical, therapeutic and evolutionary aspects of POSF in our context. Methodology: This was a retrospective study from August 2018 to November 2023 in children with POF. The variables studied were: age, sex, fistula characteristics, indication of original intervention, etiology of fistulas, treatment and short-term course. A total of 12 files were collected. Results: FDPO represented 3% of the digestive emergencies operated in this period. The mean age was 8.6 years (range: D40 and 15 years) with a sex ratio of 1.4. The mean time to fistula onset was 10 days (range: 5 and 15 days). The fistula was at the level of the ileum (n=9). The efferent opening of the fistula was located at the level of the operative wound (n=11) and at the drainage port (n=1). The indication for the original procedure was dominated by appendicular peritonitis (n=7). Fistulas followed deperitonization (n=7). Medical treatment was systematic in all patients and resulted in spontaneous closure (n=6) within a mean time of 29.8 days. Five fistulas required surgical treatment. Ileostomy was the most performed procedure in operated fistulas (n=3). Two deaths were observed, one before surgical management of the fistula and the other postoperatively in a picture of septic shock and malnutrition. The mean length of hospital stay was 62 days (range 27 to 130 days). Conclusion: POFs are characterized by significant morbidity and mortality. Their prevention requires compliance with the precise rules of surgical technique and their management justifies the implementation of resuscitation measures. Keywords: Digestive fistula, Postoperative, Child.