Management of Enterocutaneous Fistulas

  • Maria Michailidou


An enterocutaneous (EC) fistula is defined as an abnormal connection between the gastrointestinal (GI) tract and the skin. The majority of EC fistulas are iatrogenic due to a missed enterotomy or anastomotic leak, and are generally defined based on their etiology, location and daily output. Patients may present either with drainage of enteric contents from the surgical site/abdominal wall or with abdominal pain, ileus, fevers, malaise, and computer tomography (CT) findings consistent with an intraabdominal abscess. Regardless of etiology, initial management requires a multidisciplinary approach consisting of fluid resuscitation, characterization of EC fistula and intraabdominal collections with cross-sectional imaging, control of sepsis, nutritional support, and local wound care. Spontaneous closure occurs in about one third of patients in the first 4–6 weeks after formation. Risks factors for nonspontaneous closure include high fistula outputs, distal obstruction, ongoing infection, inflammatory bowel disease, epithelialized or short (<2 cm) fistulous tract, retained foreign body such as mesh, and presence of underlying neoplasia. Definitive surgical management should be deferred at least 12 weeks from fistula formation in patients whose nutrition has been maximally optimized and sepsis has been completely controlled. Surgical management consists of lysis of adhesions and takedown of EC fistula with resection of affected bowel and may require complex abdominal wall repair.


Enterocutaneous fistula Fistulogram Anastomotic leak Abdominal wall reconstruction 


  1. 1.
    Gribovskaja-Rupp I, Melton GB. Enterocutaneous fistula: proven strategies and updates. Clin Colon Rectal Surg. 2016;29(2):130–7.CrossRefGoogle Scholar
  2. 2.
    Rahbour G, Siddiqui MR, Ullah MR, Gabe SM, Warusavitarne J, Vaizey CJ. A meta-analysis of outcomes following use of somatostatin and its analogues for the management of enterocutaneous fistulas. Ann Surg. 2012;256(6):946–54.CrossRefGoogle Scholar
  3. 3.
    Misky A, Hotouras A, Ribas Y, Ramar S, Bhan C. A systematic literature review on the use of vacuum assisted closure for enterocutaneous fistula. Color Dis. 2016;18(9):846–51.CrossRefGoogle Scholar
  4. 4.
    Amiot A, Setakhr V, Seksik P, Allez M, Treton X, De Vos M, et al. Long-term outcome of enterocutaneous fistula in patients with Crohn’s disease treated with anti-TNF therapy: a cohort study from the GETAID. Am J Gastroenterol. 2014;109(9):1443–9.CrossRefGoogle Scholar
  5. 5.
    Brenner M, Clayton JL, Tillou A, Hiatt JR, Cryer HG. Risk factors for recurrence after repair of enterocutaneous fistula. Arch Surg (Chicago, Ill: 1960). 2009;144(6):500–5.CrossRefGoogle Scholar
  6. 6.
    Visschers RG, van Gemert WG, Winkens B, Soeters PB, Olde Damink SW. Guided treatment improves outcome of patients with enterocutaneous fistulas. World J Surg. 2012;36(10):2341–8.CrossRefGoogle Scholar
  7. 7.
    Krpata DM, Stein SL, Eston M, Ermlich B, Blatnik JA, Novitsky YW, et al. Outcomes of simultaneous large complex abdominal wall reconstruction and enterocutaneous fistula takedown. Am J Surg. 2013;205(3):354–8; discussion 8–9.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Maria Michailidou
    • 1
  1. 1.Department of SurgeryPenn State Milton S. Hershey Medical CenterHersheyUSA

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