Spontaneous Closure of High-Output Duodenal Enteroatmospheric Fistula with Fistuloclysis: Case Report

High-output duodenal enteroatmospheric fistulas (EAFs) are a formidable surgical challenge associated with high morbidity and mortality. Fistuloclysis, the reinfusion of proximal intestinal effluent into the distal bowel, is a management strategy aimed at preserving gut function and mitigating catabolism. We report the successful management of a 71-year-old male who developed a high-output (1,300 mL/day) duodenal EAF following a distal partial gastrectomy with Roux-en-Y reconstruction. Fistuloclysis was initiated on postoperative day seven via a feeding jejunostomy. Over a 14-day treatment period, the patient's nutritional status markedly improved, and fistula output progressively decreased to 25 mL/day. This effective effluent control resulted in the spontaneous functional closure of the tract, obviating the need for immediate surgical intervention. The patient was discharged with a granulating tract and remained recurrence-free at outpatient follow-up. This case highlights fistuloclysis as a safe and effective alternative to parenteral nutrition in managing complex duodenal EAFs. The technique was critical in reversing the patient's catabolic state, controlling fistula output, and facilitating spontaneous closure. We advocate for its early consideration in the multidisciplinary management of these challenging fistulas.