Different approaches in the management of enterocutaneous fistula


  • Deepika Department Of General Surgery, Patna Medical College and Hospital, Patna, Bihar, India
  • Saima Anjum Department Of General Surgery, Patna Medical College and Hospital, Patna, Bihar, India




ECF, Conservative approach, Secondary exploration


Background: Enterocutaneous fistula (ECF) are abnormal communications between the skin and gastrointestinal tract. ECF are a difficult and costly surgical complication to manage.

Methods: The aim of this study is to compare the outcomes and review the different approaches in the management of ECF. We conducted a retrospective study on 50 postoperative ECF patients after abdominal surgeries over a period of 10 months admitted through PMCH OPD and emergency. We included 30 men and 20 females between age 10-70 years. We excluded spontaneous fistula in Crohn’s disease, intestinal diverticulosis, or any inflammatory disease.

Results: Out of 50 patients of ECF 42 (8%) were managed conservatively initially. Out of that 9 patients failed to respond to conservative management and required later secondary exploration. Eight patients (16%) needed initial primary surgical intervention after formation of faecal fistula and peritonitis. The overall incidence of ECF is 4% varied according to surgery type, -4% after colorectal surgeries, 7% after gastroduodenal surgeries, 0.5% after extra-digestive surgery. Conservative approach includes resuscitation, nutritional support, sepsis control, output control and skin protection whereas in Surgical management we included permanent closure of fistula, resection of fistula tract, anastomosis and excision of tract and direct drainage.

Conclusions: Conservative treatment plays a pivotal role as an initial management in both low and high fistula output. There was no significant recurrence rate difference seen in conservative and surgical approach.


Enterocutaneous Fistula: Proven Strategies and Updates Irena Gribovskaja-Rupp, MD1 and Genevieve B. Melton, Clin Colon Rectal Surg. 2016;29(2):130-37.

Kevin BC, Sebastiano C. Enterocutaneous Fistula. StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.

Faizo VW, Coutsofites T, Steiger E. Factors influencing the outcome of treatment of small bowel cutaneous fistula. World J Surg. 1983;7(4)481-8.

Draus JM Jr, Huss NJ Cheadle WG, Larson GM. enterocutaneous fistula: are treatments improving. Surgery. 2006;140(4):570-76.

McIntyre PB, Ritchie JK, Hawley PR, Bartram CI. Lennaed-jones JE. management of enterocutaneous fistula: a review of 132 cases. Br J Surg. 1984;71(4);293-6.

Dumas RP, Moore SA, Sims CA. Enterocutaneous Fistula: Evidence-based Management. Clin Surg Emerg Surg. 2017;2:1435.

Haack CI, Galloway JR, Srinivasan J. Enterocutaneous Fistula: A Lookat causes and management. Curr Surg Rep. 2014;2:71.

Owen MR, Love TP, Perez SD, Srinivasan JK, Sharma J, Sharma J et al. Definitive surgical treatment of entero-cutaneous. JAMA. 2013;148(2):118-26.

Evenson AR, Fischer J. Current management of enterocutaneous Fistla J Gastrointest Surg. 2006;10(3):455-64.

Metcalf C. Considerations for the management of enterocutaneous fistula. Br J Nurs. 2019;28(5):S24-31.

Nirmal I. Effluent control in enterocutaneous fistula- experience of an Enterostomal Therapist. J Nurs Health Care. 2017;6(3):1-6.

Manos LL, Wolfgang CL. The Management of Enterocutaneous Fistula, Current surgical therapy 11th ed, Saunder, an imprint of Elsevier Inc Philadelphia, PA,USA. 2014;142-5.

Pritis TA, Fischer JE. Postoperative Enterocutaneous fistula in surgical treatment-Evidence-Based and problem-oriented. Rene G, Holzheimer JA, Mnnick W, Eds. Zuckschwerdt, Munchen, Germany. 2001.

Guo Y, Guo W. De-escalation of empiric antibiotics in patients with severe sepsis or septic shock, a meta-analysis. Heart-Lung. 2016;45(5):454-9.

Hesse U, Ysebaert D, Hemptinne B. Role of Somatostatin and its analogues in the management of gastrointestinal fistulae. Gut. 2001;49(4):iv11-21.

Heimroth J, Chen E, Sutton E. Enterocutaneous Management approach for Enterocutaneous Fistula. Am Surg. 2018;84(3):326-33.

Galie KL. Postoperative Enterocutaneous Fistula; when to operate and how to succeed. Clin Colon Rcetal Surg. 2006;19(4):237-46.

Dellinger F, Levy MM, Carlet JM, Julian B, Margaret MP, Roman J et al. Surviving Sepsis Campaign; International guidelines for management of severe sepsis and septic shock. Crit Care Med. 2008;36(1):296-327.

Duddrick SJ, Mharaj AR, McKinley AA. Artificial nutrition support in patients with gastrointestinal fistula. World J Surg. 1999;23(6):570-6.

Polk TM, Schwab CW. Metabolic and nutritional support of the Enterocutaneous fistula: A three-phase approach. World J Surg. 2012;36(3):524-33.

Connolly TP, Teubner A, Lees NP, Anderson ID, Scott NA, Carlson GL. Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg. 2008;247(3):440-44.

Davis KG, Johnson EK. Controversies in the care of the Enterocutaneous Fistula. Surg Clin N Am. 2013;93(1):231-50.

Schechter W, Hirschberg A. Enteric Fistula: Principle of management. J Am Coll Surg. 2009;10:455-64.




How to Cite

Deepika, & Anjum, S. (2023). Different approaches in the management of enterocutaneous fistula. International Journal of Research in Medical Sciences, 11(12), 4318–4323. https://doi.org/10.18203/2320-6012.ijrms20233516



Original Research Articles