Introduction: The successful treatment of an enterocutaneous fistula (ECF) is challenging even for experienced surgeons, as it is associated with potential complications such as infection, abdominal sepsis, dys-electrolytemia, septic shock and malnutrition. All of these conditions may congregate and lead to increased mortality in these patients in addition to the original trauma. Case Report: We describe a 27-year old male who was shot in the left thoraco-abdominal region without an exit wound. On laparotomy, multiple injuries to jejunum, ileum and sigmoid were identified. Primary repair of sigmoid, end-to-end jejunostomy and end-to-end ileostomy was performed. On postoperative day 10, an ECF erupted as a low output fistula (100 ml/24h). The patient was put on full parenteral treatment. Following work up including CT scan and fistulogram, the patient was taken back to the operating room for washout and diverting ileostomy with fistula tract resection. He fully recovered uneventfully following this second operation. Conclusion: Early surgical treatment may work out advantageously compared to possible conservative treatment in low output fistulas following a gunshot of the thoraco-abdominal region.