Management of External Small Bowel Fistulas

Fistulas between the small bowel and the abdominal wall continue to present complex and challenging problems for the surgeon. Although these fistulas may result from inflammatory or neoplastic diseases of the bowel, they are most often the unintentional result of a surgical procedure.^1,2 Some fistulas are small and are relatively innocuous. These may close spontaneously. In contrast, small bowel fistulas with profuse drainage, "high output" fistulas, are serious lesions and are associated with a high mortality.³ The copious drainage of small bowel contents causes serious disturbance of fluid and electrolyte balance. Sepsis, nutritional deficits, and excoriation of the skin are important factors which contribute to the associated high morbidity and mortality.²

Clinical Material  The present report is based on a study of 18 patients with external small bowel fistulas who were treated at the Chicago Wesley Memorial Hospital and the Veterans Administration Research Hospital over a period