Surgical management of high output enterocutaneous fistulae: a 24-year experience

Enterocutaneous fistulae are abnormal communications between the small or large bowel and the skin, which may be lined with epithelium or associated with intra-abdominal sepsis. Patients with high fluid and electrolyte losses are best managed in a nutrition unit by a dedicated team of physicians and other healthcare workers. Despite recent advances in the management of these patients, the mortality rate ranges between 10 and 20%. It is therefore imperative that attention must be paid to well-designed management protocols.

A total of 494 patients with high-output enterocutaneous fistulae were reviewed over a 24-year period. The overall mortality rate of the patients was 13%. A pilot study evaluating somatostatin in combination with total parenteral nutrition showed promise in the conservative management of high-output enterocutanous fistulae, but the use of somatostatin is controversial, and it should not be used routinely. Although H2 receptor antagonists and proton pump inhibitors decrease gastric secretions, they do not help in closing enterocutaneous fistulae.

Sepsis, in all its forms, is an important cause of morbidity and mortality and requires aggressive treatment. Definitive surgical closure of the fistula should only be performed when the patient is apyrexial and in good nutritional status, and if the fistula effluent shows no signs of decreasing in volume after 4-6 weeks of nutritional support. All reviews of patients with enterocutaneous fistulae reveal that the best results with the least morbidity are obtained by definitive resection and end-to-end anastomoses.