Total parenteral nutrition in management of external small bowel fistulae.
Prospective and retrospetive analyses were made of 34 patients with small bowel fistulae treated with and without total parenteral nutrition (TPN) between 1970--1981. The administration of TPN in the management of small bowel fistulae increased their rate of closing and decreased the number of permanent fistulae. No improvement was observed in mortality (44%). More than 90% of the deaths occurred in patients with uncontrolled sepsis. In patients older than 65 years a decreased healing tendency and a rise in mortality rate up to 80% was found despite TPN. In patients with high-output fistulae, inflammatory bowel disease and malignancy, good results could be reached with TPN. The suggested plan for management of small bowel fistulae is based upon initial nonoperative therapy, nutritional support, vigorous control of sepsis. These facilitate spontaneous healing or allow surgical closure in the optimal time.
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D007421:Intestine, Small; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000379:methods*; D010289:Parenteral Nutrition, Total / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012871:Skin Diseases / Q000401:mortality / Q000601:surgery / Q000628:therapy*