A newly developed nomogram predicts spontaneous closure in septic patients with external duodenal fistulas post-infection control, critical for surgery decisions.

• Spontaneous closure rates after infection control were 53.2% in the development cohort and 57% in validation.
• Six key factors were identified: time to infection control, infection extent, emergency surgery, fistula size, duodenal decompression, and albumin use.

This tool provides surgeons with a reliable method to assess closure risk, potentially guiding treatment strategies.

• The nomogram’s predictive accuracy was strong, with c-indices of 0.82 and 0.76 for the two cohorts.