Treatment of postoperative peritonitis of small-bowel origin with continuous enteral nutrition and succus entericus reinfusion.
OBJECTIVE
Proximal intestinal stomas established by the exteriorization of leaking anastomosis in the presence of peritonitis can be used to reinfuse succus entericus and provide adequate enteral nutrition.


METHODS
Retrospective analysis of prospectively gathered data from a cohort of consecutive patients admitted between January 1993 and December 1999 for postoperative peritonitis requiring laparotomy and the construction of one or more small-bowel stomas.


METHODS
Tertiary referral center with a surgical intensive care unit experienced in the treatment of intra-abdominal sepsis and succus entericus reinfusion.


METHODS
Twenty-one consecutive patients with postoperative peritonitis originating from a jejunal or ileal leak. We excluded patients with established enterocutaneous fistulae, abscesses amenable to percutaneous drainage or other conservative treatments, and postoperative peritonitis caused by ileocolic or ileorectal anastomosis.


METHODS
Early laparotomy with exteriorization of small-bowel leak(s), and continuous enteral nutrition (CEN) and succus entericus reinfusion (SER) via the distal portion of the stoma until gastrointestinal continuity was restored.


METHODS
Feasibility of CEN and SER with temporary, diverting small-bowel stomas and their associated postoperative morbidity and mortality rates.


RESULTS
One patient died, and 14 experienced complications. For technical reasons, CEN and SER were discontinued early on in 7 patients. The mean duration of CEN and SER was 58 days and 61 days, respectively. Enteral feedings allowed the suppression of central venous access after a median of 28 days, with 82 days as a median time to restoration of intestinal continuity.


CONCLUSIONS
Although the exteriorization of small-bowel leaks with CEN and SER is generally feasible and effective in the treatment of critically ill patients with peritonitis secondary to small-bowel leaks, it is associated with significant morbidity and mortality, in part relating to patients' underlying diseases.
Calicis
B
B
Department of Digestive Surgery, Hôpital Saint-Antoine, University Pierre et Marie Curie, 184 rue du Faubourg Saint-Antoine, F-75571 Paris, France.
Parc
Y
Y
Caplin
S
S
Frileux
P
P
Dehni
N
N
Ollivier
J-M
JM
Parc
R
R
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D016638:Critical Illness; D004750:Enteral Nutrition / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000009:adverse effects; D007419:Intestinal Secretions; D007421:Intestine, Small / Q000601:surgery*; D007582:Jejunostomy / Q000009:adverse effects; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome