Enterocutaneous Fistula Caused by an Ingested Chicken Bone in an Adult: A Case Report

Introduction and Importance: Enterocutaneous fistulas (ECFs) caused by ingested foreign bodies are extremely rare. Accurate fistula localization is essential for guiding management, especially in comorbid patients at high surgical risk. Case Presentation: We report a 76-year-old woman who developed an ECF secondary to a swallowed chicken bone. Initial imaging suggesting a high small-bowel fistula and severe peristomal skin breakdown prompted consideration of surgery. Extended conservative management allowed skin healing, and follow-up imaging revealed a more distal fistula, supporting continuation of nonsurgical management. Clinical Discussion: Management of ECF is challenging due to morbidity from intestinal failure, electrolyte disturbances, sepsis, and skin damage. Optimal care requires multidisciplinary strategies guided by sepsis control, nutritional support, anatomical assessment, and procedure planning (SNAP framework). Conclusion: This case highlights the importance of individualized management and careful assessment of fistula location. It also illustrates that prolonged conservative management can achieve acceptable outcomes in high-risk patients.