The successful conservative management of high-output entero-cutaneous fistulae.

Until recent years it has been thought prudent to reoperate for high-output enterocutaneous fistula complicating abdominal surgery. With the advent of adequate parenteral nutrition, however, providing calories and balanced intake, this concept is challenged. Three case reports describe spontaneous closure of high-output fistula over three to four months, in patients in whom surgical reintervention had proved, or would have proved, technically extremely difficult. In the first patient, a fistula had been resected once with recurrence; in the second, a fistula had been resected once, with recurrence, and at a further operation it was found technically impossible to appose the bowel ends for anastomosis; the third patient demonstrates the success of a conservative approach from the outset. A suggested regime for long-term parenteral therapy is outlined. Some complications of such long-term intravenous therapy and patient care arc mentioned.