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Sau phẫu thuật đường tiêu hóa fistulae có thể phát sinh do ruột chấn thương từ một trong ba cơ chế có thể sau phẫu thuật bụng (Hộp 3.1). Việc quản lý toàn cầu của bệnh nhân rò hậu phẫu có thể được tóm tắt bằng cách sử dụng "4 Rs": hồi sức, phục hồi, | 3 Management of gastrointestinal fistulae NIGEL SCOTT Introduction Post-operative gastrointestinal fistulae can arise due to gut injury from one of three possible mechanisms following abdominal surgery Box 3.1 . The global management of the post-operative fistula patient can be summarised using the 4 Rs Resuscitation Restitution Reconstruction and Rehabilitation. This article outlines the approach of the Intestinal Failure Unit at Hope Hospital Manchester UK in dealing with intestinal fistulae.1 2 Box 3.1 Causes of post-operative fistulae Unrecognised intestinal injury Breakdown of serotomy repair Breakdown of anastomosis Resuscitation Septic patients with multiple organ failure require immediate assessment and support of the airway breathing and circulation with patient transfer to a surgical high dependency unit HDU or the intensive care unit ICU for monitoring and or organ support if indicated. Large losses of gastrointestinal fluid directly equates with large losses of saline since the enteric fluid sodium content is approximately 110mmol l saline fluid resuscitation is therefore commonly required. Discharge of corrosive enteric enzymes and bile salts produces skin destruction and protection of the skin and collection of these losses requires time-consuming and dedicated nursing resources. In addition the morale of the patient and relatives and also staff morale requires a form of resuscitation - if the fistula becomes a difficult and long term problem. 21 CRITICAL CARE FOCUS THE GUT Restitution Restitution is the restoration of the patient s biology to a situation where either spontaneous closure of the fistula can take place or it is reasonable to carry out surgical correction of the fistula. Thus after the immediate assessment and resuscitation of the post-operative fistula patient the next stage is to restore him or her to a state from which fistula closure -spontaneous or surgical - can take place. This requires attention to the acronym SNAP which stands .
