High output enterocutaneous fistula of the afferent loop in a partially gastrectomized patient treated by clinical nutrition.

A case of high output enterocutaneous fistula, in a patient presenting with an epigastric mass and a severe state of denutrition, which healed spontaneously on TPN and drainage is reported. Twenty years previously the patient hed been submitted to partial gastrectomy and gastrojejunoanastomosis for peptic ulcer. Fistulography and upper GI radiography revealed that the enteric opening of the fistula was located in the afferent loop, about 20 cm distai to the greater curvature of the stomach. The presence of pancreatic enzymes and a large amount of sodium in the drainage fluid suggested a high enterocutaneous communication. Complete closure of the fistula was observed 60 days after the start of TPN, wich was thus replaced by oral feeding. Long-term clinical nutrition in conjunction with minor surgical procedures, performed to prevent the spread of infection, may in some cases replace the need for major surgery and determine the sportteneous healing of enterocutaneous fistulas.