Enterocutaneous fistulae represent abnormal communication between some part of digestive organ and abdominal wall, from which gastric or enteric contents are drained externally for 48 hours or more.
Though many concepts important to their management are estabilished the enterocutaneous fistulae still can cause high morbidity and mortality, and particularly the secondary complications, such as fluid and electrolyte imbalance, infection and
malnutrition may lead to progressive deterioration of the conditions of patients.
In the treatment of fistulae, the importance of adequate nutrition had been emphasized, and expecially after the introduction of the technique of long term parenteral nutrition by Dudrick in 1968, Total parenteral nutrition (TPN) could have been
able to
provide effective and simple method to the management of patients with external enterocutaneous fistulae.
Authors have analysed sixty-four cases of external enterocutaneous fistulas treated at the Department of surgery, Pusan National University Hospital from January, 1988 to December, 1992, and the results obtained were summarized as follows:
1) The sites of origin of fistulae were jejunum in 17 cases(26.6%), ileum 14 cases(21.9%), duodenum 10 cases915.6%) and etc. The number of high and low output fistulae were 40 cases(62.5%) and 24 cases(37.5%) respectively.
2) The major underlying diseases were traumatic bowel perforation in 12 cases(18.9%), adhesive ileus in 11 cases(17.2%), appendicitis and stomach cancer in 6 cases(9.4%) respectively. The operative procedure performed for underlying disease were
adhesiolysis and segmental resection of small intestine in 11 cases(17.2%) respectively, segmental resection of colon in 9 cases(14.1%) and etc.
3) According to arthropometric assessment, the number of patients with risk or severely depleted state were 42 cases(65.6%) before TPN and 12 cases(18.8%) after TPN. According to nutritional assessment using total lymphocyte counts, level of
serum
albumin and transferrin, the numbers of patients with moderate or severe malnutrition were 29 cases(45.3%), 34 cases (53.1%), 44 cases(68.8%) before TPN and 10 cases(15.6%), 7 cases(11.0%) and 9 cases(14.1%) after TPN respectively.
4) Of all 64 cases, 55 cases(85.9%) were cured with TPN and without reoperation, 9 cases(14.1%) were treated with reoperation. Reoperation was performed within 30 days in 2 cases(3.1%) and 5 cases (7.8%) after 91 days.
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