Octreotide in the management of postoperative enterocutaneous fistulas and stress ulcer bleeding

We report two clinical experiences in the treatment of postoperative enterocutaneous fistula and stress ulcer bleeding with octreotide acetate (Sandostatin). In both patients, upper gastrointestinal bleeding occurred 7 days after operation, and the bleeding proved to be stress ulceration, by panendoscopic examination. Enterocutaneous fistulas also were found in both patients. One was high output (750 ml/day), and the other was low output (50 ml/day). Octreotide 50-100 μg was given subcutaneously every 8 h. After three doses of octreotide, a significant reduction in fistula output and control of the stress ulcer bleeding were noted. The fistulas closed promptly after nine doses of octreotide, but the first patient's fistula recurred 2 days later, with fluid losses of about 100-200 ml/day. This fistula closed spontaneously 1 month after discharge. Octreotide appears to be useful as an adjunct to the conventional treatment of enterocutaneous fistulas, especially those complicated by stress ulcer bleeding.