Description of past management:  Non pouching techniques are often utilized in the pediatric population in the care of an enterocutaneous fistula. When utilizing a pouch, the selection of a pouch is often limited to the use of a pouching system that is too large for the size of the patient.

Current clinical approach: The patient was admitted with liver and intestinal failure. Surgical intervention was attempted to repair the existing fistula and place his intestines back into continuity. The hope was to be able to advance feedings and rehabilitate the remaining bowel with the hopes of only requiring a liver transplant for the patients recovery. His surgical procedure was further complicated by high blood loss and a resulting ARDS. Postoperatively the wound dehisced and eventually resulted in more enterocutaneous fistulas. The patient was listed for liver small bowel transplant.

Patient outcomes: The patient was pouched in an adult pouching system to contain the high output of his small bowel fistula. The perifistular skin remained intact during his wait for organ transplantation.  Conclusions:  Pediatric abdominal recipients wait on the UNOS list longer than adults and the number of patients waiting has increased over the past decade.There is a potential for death while waiting for organs and is  highest for candidates waiting for combined liver-intestinal allografts.The potential for wait-list mortality is even higher for small candidates less than one-year of age. The patient died waiting for his transplant from multi organ failure.