The gastrointestinal breach: understanding enterocutaneous fistula


  • Rajeev M. Joshi Department of Surgery, T.N. Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
  • Gagan Soni Department of Surgical Disciplines, AIIMS, New Delhi, India
  • Asma Khalife Department of Surgery, T.N. Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
  • Deepak Ranvir Department of Surgery, Dr. R. N. Cooper Municipal General Hospital, Mumbai, Maharashtra, India
  • Bhushan Telang Department of Surgical Oncology, Government Medical College, Aurangabad, Maharashtra, India



Fistula, ECF, Management


The term "fistula" usually refers to abnormal communication between two epithelial surfaces and an enterocutaneous fistula (ECF) is an abnormal communication between any part of gastrointestinal (GI) tract and skin and lined by epithelium or granulation tissue. Common causes include trauma during abdominal surgery, inflammatory bowel disease, malignancy, infection, radiation etc. Sepsis and malnutrition are the leading causes of mortality. In cases of high-output fistula, it is essential to adequately replace the excessive fistula discharge. The patient's nutrition plays a crucial role in the successful management of ECFs. If the patient can tolerate oral or enteral feeding, it should be initiated promptly. However, if oral intake is not feasible, parenteral nutrition should be considered. Adequate wound care, including diligent skincare and timely drainage of localized abscesses, is necessary. Before conducting definitive investigations and initiating treatment, it is important to ensure proper resuscitation and stabilization of the patients. Surgical intervention should be approached in staged manner and should not be rushed to prevent failure in managing this complex condition. To conclude management of ECF is complicated and needs multidisciplinary approach. Initial focus for remedy is on treating fluid and electrolyte disturbances, comprehensive treatment of sepsis, management of fistula output, skin care and psychological support.


Davie M, Yung DE, Plevris JN, Koulaouzidis A. Aortoenteric fistula: a rare but critical cause of small bowel bleeding discovered on capsule endoscopy. BMJ Case Rep. 2019;12(5):230083.

Šumskienė J, Šveikauskaitė E, Kondrackienė J, Kupčinskas L. Aorto-duodenal fistula: a rare but seriousco mplication of gastrointestinal hemorrhage. A case report. Acta Med Litu. 2016;23(3):3380.

Di Saverio S, Tarasconi A, Walczak DA, Cirocchi R, Mandrioli M, Birindelli A et al. Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review. Langenbecks Arch Surg. 2016;401(1):1-13.

Haack CI, Galloway JR, Srinivasan J. Enterocutaneous Fistulas: A Look at Causes and Management. Curr Surg Rep. 2014;2:71.

Periselneris N, Bong JJ. Choledocho-duodenal fistula encountered during emergency laparotomy for upper gastro-intestinal haemorrhage: what should be the surgical strategy. Clin Ter. 2011;162(6):547-8.

Farooqi N, Tuma F. Intestinal Fistula. StatPearls. Treasure Island. 2020.

Waheed A, Mathew G, Tuma F. Cholecystocutaneous Fistula. Treasure Island. 2019.

Klek S, Forbes A, Gabe S. Management of acute intestinal failure: A position paper from the European Society for. Clinical Nutrition and Metabolism (ESPEN) Special Interest Group. Clin Nutr. 2016;35(1):1209-18.

Kaushal M, Carlson GL. Management of Enterocutaneous Fistulas. Clin Colon Rectal Surg. 2004;17(2):79-88.

Badrasawi M, Shahar S, Sagap I. Nutritional Management in Enterocutaneous Fistula. What is the evidence? Malays J Med Sci. 2015;22(4):6-16.

Lamazza A, Fiori E, Sterpetti AV, Schillaci A, De Cesare A, Lezoche E. Endoscopic placement of selfexpandable metallic stents for rectovaginal fistula after colorectal resection: a comparison with proximal diverting ileostomy alone. Surg Endosc. 2016;30(2):797-801.

Haito-Chavez Y, Law JK, Kratt T. International multicenter experience with an over-the-scope clipping device for endoscopic management of GI defects. Gastrointest Endosc. 2014;80(4):622-10.






Review Articles