Enterocutaneous fistula: Update in 2026

Enterocutaneous fistulas (ECF) represent a complex condition. Management strategy is based on a combination of treatment of sepsis, correction of fluid and electrolyte imbalances, nutritional optimization, anatomical assessment, and management planning. The approach is necessarily multidisciplinary (nutritionists, enterostomal therapists, interventional radiologists, anesthesiologists, intensive care specialists, and surgeons). Fitting of skin prostheses remains a challenge and requires specialized enterostomal nursing expertise. Current nutritional recommendations are for 25-35kcal/kg/day with 1.5 to 2.5g/kg/day of protein, depending on the severity of muscle wasting. Parenteral nutrition plays a central role in the initial period. Re-instillation of chyme, when feasible (proximal and distal individualized fistula orifices), provides downstream intestinal stimulation, an ileal brake effect, improved liver function, and preparation for restoration of intestinal continuity. Enteral nutrition can be gradually increased as tolerated, and oral nutrition can even be considered in certain cases when the fistula is well controlled. This has real psychological benefits for the patient. Surgical management is most often delayed, but a recent study shows that early curative surgery (