The importance of adequate nutrition in closure of small intestinal fistulas

Abstract

Abstract Ninety-one patients with small intestinal fistula, exclusive of the peforated duodenal stump and fistula in patients with carcinomatosis, were treated over the period 1960–73. Four regimens were used which permit comparison of early surgery, late surgery and nutritional support without surgery (1500–5000 kcal daily by the intravenous route). A lower mortality (8 per cent) resulted when patients were supported nutritionally combined with late definitive surgery if required after the peritonitis had subsided. The other groups in which no special effort at nutritional support was made resulted in a 33 per cent mortality rate. Spontaneous closure of the fistula occurred in 21 per cent of the group without nutrition and in 56 per cent of the nutrition group. Definitive late surgery was required for distal obstruction, Crohn's disease and undrained abscess. Total intravenous feeding is especially important in patients with fistula associated with peritonitis and sepsis.