The diagnosis is that of complex intestinal fistulae. These may complicate Crohn's disease, radiation enteritis or follow surgery for peritonitis. The principles of treatment are bowel rest using total parenteral nutrition; reducing intestinal secretions by the use of Proton Pump inhibitors and Octreotide; investigating the extent of the fistulae and the underlying pathology; controlling any associated sepsis. Once nutritional stabilisation has taken place and sufficient time has been allowed for wound healing, then corrective surgery from an expert gastrointestinal unit is required.