Medical and surgical management of enterocutaneous fistula

Development of enterocutaneous fistula (ECF) remains a challenging complication of gastrointestinal surgery and fistulizing disease processes. Successful management of ECF is dependent on timely diagnosis, effective treatment of resulting intra-abdominal sepsis, wound/nutrition management, and supporting the patient though the perioperative optimization period. When approached in multi-disciplinary setting with teams specializing in ECF/intestinal failure, care is optimized and can allow for patients to have greater independence even with complex wounds. While resolution of the ECF remains the overarching goal, a methodical and stepwise approach to management remains paramount both before and after surgical intervention. This chapter outlines ECF management from initial diagnosis to intra-operative decision making after a patient is deemed a candidate for surgery. Further, it highlights patient-specific considerations that can be overlooked in the big picture view of ECF management. While ECF treatment is challenging, the chance to cure a patient of their fistula is a rewarding experience for the patient and ECF/intestinal failure team members alike.