[Postoperative enterocutaneous fistulae of the small gut (author's transl)]

Postoperative enterocutaneous fistulae are fortunately rate (1 : 1000), but they carry a mortality of about 50%. The authors analyse the development and treatment of fistulae in 30 patients. This depends on whether the cause of the fistula is connected with an anastomosis or not, on a variety of pathologic-anatomical criteria and in particular on the amount of fluid lost daily. If this loss is less than 500 ml/24 h the fistula can be regarded as relatively benign and in all probability conservative treatment alone will succeed. Fistulae with a fluid loss of more than 500 ml/24 h have a worse prognosis and require a combined conservative and surgical therapy. The key to this problem is the optimal time for surgical intervention, it lies around the 4th week. In case an early operation is necessary one must be prepared for an enterostomy or by-pass procedure.