Introduction: Management of enterocutaneous fistulas (ECF) in patients with short bowel syndrome (SBS) is challenging. High output fistulas are unlikely to close spontaneously; however, the success rate of surgical intervention is limited due to poor nutrition, inflammation, limited bowel length and lack of abdominal wall integrity. Here, we describe 8 cases of utilizing complete jejunal exclusion at the ligament of Treitz with a gastrostomy tube drainage to manage the ECF as a temporary measure for subsequent bowel reconstruction or transplant. To our knowledge, this is the first report of this approach. Methods: Eight patients who underwent jejunal exclusion at our institution were retrospectively reviewed. In all cases, the jejunum was divided 1–2 inches distal to the ligament of Treitz. Both ends were oversewn. A gastrostomy tube was placed for retrograde decompression of proximal enteric secretions without pyloroplasty. In 4 cases of active ECF’s, we accessed the ligament of Treitz via a left subcostal incision to avoid the fistula. Results: The procedure was done for active ECFs (n=4), impending fistulas (n=1), bridge to transplant following desmoid tumor resection in Gardner’s syndrome (n=2), and after graft enterectomy (n=1). Four cases of active ECFs were managed elsewhere without success. All patients were discharged home on TPN. Of the 4 ECF cases, the fistula output decreased substantially in all patients and closed entirely in 2 cases. Two underwent successful reconstruction and 2 are awaiting reconstruction. One who had secondary biliary cirrhosis due to biliary obstruction and TPN induced liver disease died while waiting for multivisceral transplant (MVT). Of the desmoid tumor cases, one underwent MVT, is alive and well 8 years after transplant, while the other refused to undergo MVT and is living with TPN and g-tube decompression 6 years after the procedure. The patient who underwent graft enterectomy is listed for MVT-this patient developed acute pancreatitis after the jejunal exclusion and required G-J tube decompression. Conclusions: Jejunal exclusion is an effective and generally well tolerated option in the management of intractable ECF in patients with SBS. Associated complications include pancreatitis and liver failure. This procedure should be considered as a bridge to intestinal rehabilitation or transplantation in patients with ECFs that fail to close with medical or traditional surgical management. Table:Picture: