[Fistulas of the small intestine with evisceration. New therapeutic approach. 120 cases].

One hundred and twenty cases of post-operative jejuno-ileal fistula with evisceration are reported: 90% of the patients came from other departments. Depending on their mechanism, these fistulae fell into two categories: out-flowing fistulae (93 cases) consecutive to spontaneously opened peritonitis draining through the surgical incision, and in-flowing fistulae (24 cases) resulting from trauma of a superficial small bowel loop; 48% of open small bowel fistulae were due to a questionable operation. Unfavourable prognostic factors were: age over 50, supramesocolic initial lesion, fluid production equal or superior to 1000 ml/24 h, history of at least 2 previous median laparotomies and presence of one or several of 7 severity factors. The overall mortality rate was 46%, falling to 38.5% (inoperable cases excluded) after active treatment. The authors propose to concentrate on prolonged medical intensive care, salvage operations being reduced to a minimum. Over the last 4 years, this approach has brought down to 36% the overall mortality rate.