Enterocutaneous Fistula and Small Bowel Evisceration of Twenty-five Years’ Duration: Successful Surgical and Nutritional Management

Abstract

Enterocutaneous fistulae (ECF) are challenging consequences of surgical misadventure, inflammatory bowel disease, and other intraabdominal catastrophes. Enterocutaneous fistulae can lead to fluid and electrolyte depletion, intraabdominal and/or line sepsis, skin breakdown at the site of external drainage, and malnutrition if not treated. Successful management of patients with complex ECF must include a multidisciplinary plan of sepsis control, nutrition support, and surgical reconstruction. Recovery from massive bowel resection and surgical reconstruction ultimately depends on intestinal adaptation. We report a case of successful surgical and nutritional management of a complex ECF and small bowel evisceration that had been neglected for nearly 25 years.