Open abdomen is known as aserious consequence of various intra-abdominal pathologies. Initially, patients often have alife-threatening condition, sepsis or septic shock. Severe stress related malnutrition, mineral and fluid imbalance develop as metabolic consequences. Intestinal fistulas also occur as afrequent complication in patients with open abdomen. In such patients, acomprehensive approach is needed, including rehabilitation, nutritional support using optimal formulas, and local care for the open abdomen. Our case report presents apatient with open abdomen and enterocutaneous fistulation. Acomplex nutritional approach in the course of the disease is described and its importance is discussed. Finally, asummary of nutritional care for open abdomen patients is provided based on current recommendations.