Background. Patients with short bowel syndrome and high small bowel fistulas represent one of the most challenging categories in abdominal surgery. The prevalence of the syndrome among adults in Russia is unknown owing to the absence of a registry, and national clinical guidelines are lacking, which results in divergent approaches among surgeons, intensivists and gastroenterologists. The highest postoperative mortality is recorded for reconstructive procedures performed within the first month after fistula formation.Objective. To present the outcome of treatment of a patient with a high small bowel fistula complicated by extensive purulent wounds of the anterior abdominal wall and intestinal failure.Material and Methods. A clinical observation of patient G., 28 years old, admitted to the surgical department of the V.D. Seredavin Samara Regional Clinical Hospital on 3 May 2023 after appendectomy, early adhesive small bowel obstruction and progressive peritonitis. A two-stage approach was applied: stage one comprised sanitation procedures, resection of the fistula-bearing small bowel segment with formation of an end jejunostomy 70 cm from the ligament of Treitz, negative-pressure wound therapy (Vivano device) and nutritional and metabolic support through an implanted intravenous port system; stage two comprised reconstruction of the intestinal tract.Results. On 8 May 2023 multiple small bowel perforations were identified and resection with end jejunostomy was performed. From 19 May 2023, because of fixed evisceration of small bowel loops into the purulent midline wound, vacuum-assisted therapy was started; the dressing was removed on 1 July 2023 after substantial reduction of the wound defects. Daily jejunostomy output reached 8 L with oral intake of up to 10 L. Body weight fell from 96 kg on admission to 67 kg by day 60, with subsequent stabilisation under nutritional support. The patient was discharged on day 148 of treatment. On 11 November 2023 the reconstructive stage with entero-enteric anastomosis was performed; the postoperative period was uneventful and the patient was discharged on day 14. Since February 2024 the patient has returned to work with no impairment of gastrointestinal transit.Conclusions. Management of a patient with a high small bowel fistula complicated by extensive purulent wounds of the anterior abdominal wall and intestinal failure requires a multimodal approach and coordinated work of a multidisciplinary team. Negative-pressure therapy converts an uncontrolled fistula into a controlled one and permits reliable assessment of the volume and character of the discharge. Reconstructive surgery should be performed after nutritional rehabilitation has been achieved and the inflammatory process has resolved; the minimum preparation period may reach three months.