Fistulas are abnormal communications between two epithelialized surfaces. The causes of enterocutaneous fistulas can be remembered using the mnemonic FRIEND: Foreign body, Radiation, Inflammation/Infection/Inflammatory bowel disease, Epithelialization, Neoplasm, and Distal obstruction. Fifteen to twenty-five percent of enterocutaneous fistulas arise spontaneously as in, for example, Crohn's disease or cancer.

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Where other visitors exuded sentiment by the libraryful, Whymper remained cold, indifferent and judgemental.