Abstract:
Enterocutaneous fistula (ECF) is an abnormal communication of the gut with the
external environment through the skin.1,2 The most successful surgical intervention
for the treatment of an enterocutaneous fistula is excision and end to end
anastomosis.3,4 We discuss a successful surgical procedure for the high output
fistula in a severely malnourished adult.
Twenty three years old male presented to Trauma Center Combined Military
Hospital Rawalpindi with a midline discharging abdominal opening, later on found
to be a high output enterocutaneous fistula associated with severe excoriation of
the skin. He was a victim of a road traffic accident after which multiple
laparotomies resulted in enterocutaneous fistula formation. The output was more
than 6 times the intake per day. He was facing extreme malnutrition even after
intake of high protein diet. Anexploratory laparotomy was carried out; previous
gastrojejunostomy and hepatico-jejunostomy freshened with 15cm of jejunum
resected, which formed the fistulous opening. Enteroentrostomy (Rouxen Y) and
appendicetomy were done. The patient was closely monitored post operatively, his
gut was working properly and no discharge was seen at the previous site of the
enterocutaneous fistula.
High output enterocutaneous fistula is a very difficult condition to manage and the
morbidity of this condition is very prolonged. It is recommended to opt for
surgical intervention in severe malnutrition cases after conservative management for
better outcomes.
