Surgical and nutritional management of postoperative duodenal fistulas.
Twenty-four patients with postoperative external duodenal fistulas were managed in general surgical units over a six-year period. Management included aggressive nutritional support, localization and drainage of intraabdominal sepsis, and definitive surgical closure for those fistulas which did not close spontaneously. Spontaneous closure occurred in 92% of cases. All but one patient survived admission to hospital, and one patient died following readmission with intraabdominal sepsis resulting in a mortality of 8%. Provision of appropriate nutritional support and prompt control of sepsis has been associated with a low mortality rate and high rate of spontaneous fistula closure.
D000328:Adult; D000368:Aged; D004378:Duodenal Diseases / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D005402:Fistula / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D005743:Gastrectomy / Q000009:adverse effects; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D011183:Postoperative Complications; D012871:Skin Diseases / Q000209:etiology / Q000601:surgery / Q000628:therapy*