Utility of a C-Reactive Protein Declination Curve for Detecting Misadventure after Enterocutaneous Fistula Takedown: Opportunity for Early Detection?

Abstract

Background:

Enterocutaneous (EC) fistulae are a significant complication of abdominal surgery. The surgical takedown of EC fistulae carries a high risk of complications, including sepsis, recurrence, and mortality. Identifying biomarkers to detect complications early may improve outcomes. C-reactive protein (CRP), a marker of inflammation and tissue injury, has shown promise in predicting anastomotic leaks in colorectal surgery. This study evaluates the utility of post-operative CRP declination curves in detecting leaks after EC fistula takedown.

Methods:

This retrospective case series analyzed adult patients undergoing EC fistula takedown performed by a single surgeon at our institution over the past three years. Inclusion required documented EC fistulae, failure of nonoperative management, and at least three post-operative high-sensitivity CRP measurements. C-reactive protein, white blood cell (WBC), and temperature trends were analyzed alongside secondary outcomes: fistula recurrence, hospital stay, and complications.

Results:

Seven of 15 eligible cases met the inclusion criteria. C-reactive protein levels peaked immediately post-operatively and on average declined in patients without leaks, stabilizing by the second post-operative week. In patients with leaks, CRP levels deviated from this pattern, remaining elevated until managed. While WBC counts and temperatures showed variable trends, CRP demonstrated more consistent correlations with post-operative recovery and complications.

Conclusion:

High-sensitivity CRP may serve as a useful adjunct for early detection of post-operative leaks following EC fistula takedown. Preliminary findings support further prospective studies to validate CRP declination curves as a diagnostic tool, potentially improving monitoring and patient outcomes in this high-risk population.