Extra-abdominal closure of enterocutaneous fistula

Enterocutaneous fistula is a dread complication of gastrointestinal disease and gastrointestinal operation. These patients typically have undergone numerous abdominal operations, often with peritoneal contamination, carcinoma, and/or a history of radiation, making operation for repair daunting, if not impossible. We describe a method for closure of enterocutaneous fistula, which we have used successfully in four such patients. After failure of nonsurgical management, each patient's fistula was closed with a combination of skin, muscle, and fascial flaps after intubation of the fistula with a Malecot catheter. No intra-abdominal dissection was necessary. All fistulas healed completely. We recommend this closure in any patient who has failed surgical or nonsurgical therapy or in whom celiotomy is contraindicated or is to be avoided.