To the Editor.—In the June 1989 issue of the Archives, Mastboom et al1 described what they call "noniatrogenic" small-bowel perforations of "unknown or uncertain" cause, which developed in 14 patients treated by open treatment who underwent 3 to 17 laparotomies, and claim that the "occurrence of intestinal perforation during open treatment has not been described so far."
In fact, the article by Mastboom et al deals with a well-known and documented entity. Intestinal fistulas commonly develop in the frequently laparotomized abdomen due to the repeated mobilization and separation of bowel involved in the obliterative process. Commonly, the end result of repeated explorations is an abdominal-wall defect with multiple intestinal fistulas in its base. SitgesSerra et al2 pointed out the poor prognosis of this entity, which in their experience carried a mortality rate of 60%. Levy et al3 reported 120 cases of "exposed" intestinal fistulas opening into