# Conservative management of a delayed enterocutaneous fistula following emergency distal gastrectomy using sequential somatostatin analogues

## TL;DR

A patient with a delayed stomach fistula after emergency surgery was successfully managed without surgery using somatostatin drugs.

## Contribution

This case highlights the use of sequential somatostatin analogues in conservative management of postoperative fistulas.

## Key findings

- Non-operative management with somatostatin analogues avoided reoperation for a delayed enterocutaneous fistula.
- Octreotide reduced fistula output, and transition to Lanreotide simplified outpatient care.
- The fistula closed without surgical intervention, though spontaneous closure remains a possibility.

## Abstract

Enterocutaneous fistulas (ECFs) are serious postoperative complications associated with significant morbidity and mortality. Somatostatin analogues are widely used to reduce fistula output, although their effect on definitive closure remains uncertain. Evidence regarding long-acting formulations in postoperative ECFs is limited, particularly in the context of outpatient management. We report a case of delayed postoperative ECF following emergency distal gastrectomy for perforated gastric ulcer. The patient was managed non-operatively using sequential administration of short-acting Octreotide followed by long-acting Lanreotide. Conservative management avoided reoperation despite recurrent collections and prolonged fistula activity. Octreotide therapy was associated with reduction in fistula output, and transition to monthly Lanreotide enabled simplified outpatient care. The fistula subsequently closed without surgical re-intervention; however, spontaneous closure cannot be excluded as a contributing factor. This case emphasizes surgical decision-making in a hostile postoperative abdomen and the sequential use of somatostatin analogues in conservative community-based care.