High Output Enterocutaneous Fistula: A Case Report

Enterocutaneous fistula (ECF) is an abnormal communication of the gut with the external environment through the skin. The most successful surgical intervention for the treatment of an enterocutaneous fistula is excision and end to end anastomosis. 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.