External duodenal fistula following closure of duodenal perforation.
Article
in English
| IMSEAR
| ID: sea-64047
ABSTRACT
AIM:
Retrospective analysis of experience with management of external duodenal fistula (EDF) without using total parenteral nutrition (TPN).METHOD:
Medical records of 31 patients with EDF following closure of duodenal ulcer perforation, treated over a 7-year period (1994-2001), were studied. Twenty-one patients (68%) had evidence of sepsis at presentation or during the course of treatment. None could afford TPN for optimum time. All patients received hospital-based enteral nutrition through nasojejunal tube, besides supportive medical treatment and/or surgery. Peritonitis or failure to insert nasojejunal tube for enteric alimentation led to early surgery.RESULTS:
Two patients died of septicemia and multi-organ failure within 48 hours of admission. Fourteen patients (48.3%) initially received conservative treatment (Group I); six of them later required surgery. Fifteen patients (51.7%) underwent early surgery due to peritonitis (n=9) or failure to establish enteral feeding (n=6) (Group II); wound infection, intra-abdominal abscess and septicemia were more common in these patients than those in Group I. Survival rate was higher in Group I than in Group II (86% versus 40%; p< 0.05). Septicemia and gastrectomy were the independent factors associated with high mortality.CONCLUSIONS:
EDF can be satisfactorily managed without TPN. Successful placement of enteral feeding line, supportive treatment and delayed surgery can achieve survival in 85% of patients. Minimum intervention is recommended when early surgery is performed in peritonitis or to establish enteral feeding line.
Full text:
Available
Index:
IMSEAR (South-East Asia)
Main subject:
Aged
/
Female
/
Humans
/
Male
/
Logistic Models
/
Survival Rate
/
Retrospective Studies
/
Intestinal Fistula
/
Treatment Outcome
/
Adult
Type of study:
Observational study
/
Prognostic study
/
Risk factors
Language:
English
Year:
2006
Type:
Article
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