Management of small bowel fistulas

Fifty-two patients with fistulas that arose from the small intestine were encountered in the 6 year span between 1975 and 1981. The mortality rate in this group was 38 percent, the average hospital stay was 95 days, and 47 patients were receiving total parenteral nutrition for an average of 56 days. Intraabdominal sepsis and peritonitis forced early reoperation in eight patients in whom exteriorization of the fistula as an ileostomy and mucous fistula and reconstruction after a long interval, was a more successful means of management than were attempts at immediate resection and anastomosis. Nineteen of 44 patients (43 percent) had spontaneous closure while receiving parenteral nutrition without oral feeding. The average time span to spontaneous closure of the fistula was 25 days. Delayed reoperation was carried out after a long interval in patients without spontaneous closure. There was a high rate of success with resection of the fistula and primary anastomosis.