2-STEP IN THE TREATMENT OF ENTEROCUTANEOU S FISTULAS

Fistulas of the proximal gastrointestinal tract are associated with a high mortality rate because of the risk of peritonitis. sepsis and los s of protein and electrolytes. Six patients with enterocutaneous fistu las were treated with an operative two-step concept. First step: Treat ment of peritonitis; acurate drainage of the fistulas and open wound t reatment. Second step: Treatment of the fistula, resection of the affl icted bowel. End-to-end or end-to-side anastomosis with the jejunum an d omental pedicle graft. With this two-step treatment fistulas in thre e patients closed primarily, the fistula output of one patient was red uced so that it closed spontaneously, while one patient died as a resu lt of sepsis and one patient had a persistent fistula.