Persistent postoperative enterocutaneous fistula: pathophysiology and treatment.

The cause of an enterocutaneous fistula following an abdominal operation, in the absence of inflammatory bowel disease or irradiation damage, is often obscure. In this study, it is postulated that distal obstruction, associated with peritoneal adhesions or abscess, is the critical determinant of fistula persistence. The 'venting' effect of the fistula, and the presence of obstruction which is frequently partial, makes recognition of the obstructive element difficult. It is suggested that operations to cure postoperative fistula should be based on the assumption that distal obstruction is always present, and should include a complete lysis of adhesions involving the small and large bowel. A postoperative fistula was cured in 21 out of 23 patients treated on this basis.