Current Trauma Reports: Enterocutaneous Fistula

Purpose of Review Enterocutaneous fistulas (ECFs) are complex and resource-intensive complications in surgical and trauma care. Despite improvements in mortality over the past several decades, ECFs continue to be associated with significant morbidity, prolonged hospitalization, malnutrition, and impaired quality of life. This review examines contemporary principles of ECF management and highlights evolving therapeutic strategies. Recent Findings Modern management has shifted from prolonged bowel rest and exclusive parenteral nutrition toward a multidisciplinary approach emphasizing early source control, physiologic stabilization, and nutritional optimization with increasing focus on enteral rehabilitation when feasible. Adjunctive pharmacologic therapies, fistuloclysis, and advanced wound isolation techniques support stabilization and may improve spontaneous closure rates in select patients. Definitive surgical repair is generally delayed until inflammation has resolved and nutritional status has been optimized. Emerging therapies, including GLP-2 analogues, endoscopic closure techniques, biologic plugs, and regenerative strategies, have shown promise in early studies but require further validation. Summary Optimal ECF management requires coordinated multidisciplinary care focused on sepsis control, nutritional rehabilitation, wound management, and individualized operative planning. Although outcomes have improved substantially, important controversies persist. Continued investigation and development of standardized care pathways are needed to refine management strategies and improve patient-centered outcomes.