Surgical and nutritional management of postoperative duodenal fistulas.

Twenty-four patients with postoperative external duodenal fistulas were managed in general surgical units over a six-year period. Management included aggressive nutritional support, localization and drainage of intraabdominal sepsis, and definitive surgical closure for those fistulas which did not close spontaneously. Spontaneous closure occurred in 92% of cases. All but one patient survived admission to hospital, and one patient died following readmission with intraabdominal sepsis resulting in a mortality of 8%. Provision of appropriate nutritional support and prompt control of sepsis has been associated with a low mortality rate and high rate of spontaneous fistula closure.