The Challenge of Enterocutaneous Fistulae

During a period of three years (01.01.2009-31.12.2011), 17 cases of enterocutaneous fistulas arising from the small intestine were managed. The majority of the fistulas (76%) resulted from surgical complications. There were 6 females and 11 male patients. The mean age of the patients was 40 years. For 9 out of 17 patients (52%) the fistulae arose from the proximal small gut (duodenum and jejunum) and in the remaining 48%, from the ileum. Octreotide was used for 11/17 patients (64%). Enteral nutrition was used for 9/17 patients (52%), while re-feed from the proximal gut fistulae was used in 4/9 patients (44%) in order to maintain the nutrition of the above mentioned subjects. Only one fistula (6%) closed spontaneously. There were 2 deaths (12%) in this study. For 14 out of 17 patients (82%) the surgical intervention at some stage was required for successful closure of intestinal fistula. Aggressive surgical treatment with judicious use of octreotide, nutritional support, stoma care and control of sepsis significantly improves the outcome of small intestinal fistulae.