The Challenge of Enterocutaneous Fistulae

During a period of six years, 17 cases of enterocutaneous fistulae arising from the small intestine were managed. Majority of the fistulae, (76%) resulted from surgical complications. There were 6 females and 11 male patients. The mean age of the patients was 40 years. In 9/17 patients (52%) the fistulae arose from the proximal small gut (duodenum and jejunum) and in the remaining 48% from the ileum. Octreotide was used in 11/17 patients (64%). Enteral nutrition was used in 9/17 patients (52%) while re-feed from the proximal gut fistulae was used in 4/9 patients (44%) to maintain the nutrition of the patients. Only one fistula (6%) closed spontaneously. There were 2 deaths (12%) in this study. 14/17 patients (82%) required surgical intervention at some stage 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.