An enterocutaneous fistula (ECF) is a complex medical issue that occurs when abnormal communication between the small intestine and the skin occurs. This can lead to the leakage of digestive contents, such as feces and food, onto the skin’s surface. The case of an 86-year-old woman is presented, who developed high-output ECF after undergoing Hartmann surgery, intestinal transit reconstruction for perforated diverticulitis and incisional hernia treatment involving hernioplasty and polypropylene mesh. The patient had suffered from a serous-purulent discharge from a low-volume surgical wound for several years. Despite optimizing the patient’s nutritional status, a laparotomy and small bowel resection were performed successfully. However, using vacuum dressing as a cover for the fistula in the lower gastrointestinal tract remains a subject of debate and limited research. No officially recognized international guidelines recommend its use for small bowel ECF.