Enterocutaneous fistula as a long-term complication of jejunostomy tube placement in a dog with hyperadrenocorticism

Background Jejunostomy tube (JT) feeding is widely recommended for early nutritional support in critically ill patients or those undergoing gastrointestinal surgery. While generally well-tolerated, complications such as enterocutaneous fistula formation can occur. Hyperadrenocorticism (HAC) is associated with impaired wound healing and increased susceptibility to infections, potentially predisposing affected patients to delayed complications following enteral feeding tube placement and removal. Case Presentation An 11-year-old, 2.9 kg Maltese dog presented with persistent gastrointestinal signs and focal cellulitis with purulent discharge. The dog had previously undergone intestinal anastomosis and JT placement for foreign body removal, with an uneventful recovery. Four months postoperatively, ultrasonography and fistulography confirmed an enterocutaneous fistula extending from the subcutaneous tissue to the intestinal lumen. Concurrently, HAC was diagnosed based on a post-stimulation cortisol level exceeding 20 µg/dL following an adrenocorticotropic hormone (ACTH) test. Given HAC’s pathophysiological effects —including glucocorticoid-induced dermal atrophy, diminished tissue elasticity, and increased infection susceptibility— HAC was suspected to have contributed to fistula formation. Surgical treatment comprised jejunal resection and anastomosis, as well as excision and debridement of the fistular tract. The patient exhibited no recurrence over a three-year follow-up period with sustained medical management of HAC using trilostane therapy. Conclusions This case highlights enterocutaneous fistula as a delayed and previously unreported complication of JT placement in a dog with HAC. Given the adverse effects of HAC on wound healing, clinicians should recognize the potential for such complications and implement vigilant postprocedural monitoring and appropriate endocrine management in patients undergoing enteral tube placement.