Establishment of Complex Enteral Nutrition Pathways for Multiple Enteric Fistulas

Background: Malnutrition and sepsis remain the leading causes of death in gastrointestinal fistulas. Establishment of appropriate access of enteral nutrition is still challenging for patients with multiple fistulas. Case Presentation: We presented in this case a patient with multiple post-operative fistulas and anastomotic leakages. Because of the lack of intestinal integrity for enteral feeding, we performed a step-by-step assessment and monitoring to achieve maximum benefit. Conclusion: The establishment of nutritional feeding access to patients with multiple fistulas requires accurate assessment of sequencing of each fistula limb, percutaneous endoscopic enterostomy, and multiple times fistuloclysis to restore intestinal integrity.