Intestinal obstruction secondary to enteral feedings in burn trauma patients.
BACKGROUND
Enteral feeding is preferred for maintaining gut integrity and providing nutrition in trauma patients. Recent reports suggest that use of early enteral feeds is successful and that complications are rare. A recent burn patient, who suffered apparent bowel obstruction and perforation secondary to enteral feedings, led us to review our experience with mechanical complications of tube feedings.


METHODS
We searched our registry of patients treated for acute burn trauma injury and identified patients treated for acute bowel obstruction in the past 3 years.


RESULTS
Four patients were identified, ages 22 to 44, with burns of 6 to 92% total body surface area. Each required intubation and ventilatory support during initial treatment, complicated by adult respiratory distress syndrome and sepsis. We began enteral feeds 1 to 3 days after admission. At approximately 14 days after admission, each patient deteriorated clinically, which led to emergent abdominal exploration; the tube feedings caused bowel obstruction and associated complications. Each patient improved with laparotomy.


CONCLUSIONS
Bowel obstruction, ischemic necrosis, or both, secondary to early and aggressive nutrition with a fiber supplemented enteral feeding is an uncommon, life-threatening complication. Understanding and early recognition of this potential complication are essential to prevention or successful treatment.
Scaife
C L
CL
Department of Surgery and the Intermountain Burn Center, University of Utah Hospitals and Clinics, Salt Lake City 84132, USA.
Saffle
J R
JR
Morris
S E
SE
D000328:Adult; D002056:Burns / Q000628:therapy*; D003422:Critical Care; D004750:Enteral Nutrition; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology* / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008297:Male; D012307:Risk Factors; D013262:Stevens-Johnson Syndrome / Q000628:therapy