Enterocutaneous fistulas following laparotomy for trauma

Enterocutaneous fistulas (ECF) are recognized complications of various bowel diseases. Trauma is reported as a rare cause of ECF. ECF following laparotomy for abdominal injury was studied in 15 patients to determine whether traditional principles of management for ECF are applicable in posttraumatic ECF. Thirty-three per cent of patients with posttraumatic ECF spontaneously healed fistulas with appropriate nutritional support without operative intervention. Sixty-six per cent of patients required operative intervention, either because of associated sepsis or failure to spontaneously heal. Five patients had fistulas originate from areas of bowel not injured in the initial injury. This study suggests traditional principles of management for ECF are applicable in ECF following laparotomy for abdominal injury and result in a spontaneous closure of fistulas in one-third of patients. In addition, sepsis is the main indication for early aggressive operative treatment of these fistulas.