Postoperative small bowel fistula: back to basics.

Twenty-one patients presenting between January 1992 and January 1998 with postoperative small bowel fistula were reviewed and their management and outcome were recorded. There were six jejunal and 15 ileal fistulae. Seven fistulae were low output and 14 high output. The management principles included: (i) initial resuscitation and skin care; (ii) early surgery for sepsis, or for a high-output fistula which showed no signs of decrease by 10 days, or total wound breakdown. Surgery involved, where possible, fistula resection with double enterostomy, a feeding gastrostomy and abdominal drainage; and (iii) enteral feeding with refeeding of enterostomy output into the distal stoma if required to correct fluid and electrolyte imbalance and malnutrition. Five patients died and in the other 16 their fistulae closed and they are alive and well.