title: Outcome of acute intestinal failure.
abstract: BACKGROUND
  Type 2 acute intestinal failure is characterized by the need for parenteral nutrition (PN) for several months, and is typically caused by complications of abdominal surgery with enteric fistulas or proximal stomas. This study aimed to evaluate clinical management according to quality indicators established by the Association of Surgeons of Great Britain and Ireland.
  
  
  METHODS
  Consecutive patients with type 2 intestinal failure referred to a specialized centre were analysed. Outcomes included the rate of discontinuation of PN, morbidity and mortality.
  
  
  RESULTS
  Eighty-nine patients were analysed, of whom 57 had an enteric fistula, 29 a proximal stoma (6 with distal fistulas), and three had intestinal failure owing to other causes. One patient was deemed inoperable, and nine patients died from underlying illness during initial management. Before reconstructive surgery, 94 per cent (65 of 66 operated and 3 patients scheduled for surgery) spent the period of rehabilitation at home. Discontinuation of PN owing to restoration of enteral autonomy was achieved in 65 (73 per cent) of 89 patients. Seven patients developed a recurrent fistula, which was successfully managed with a further operation in four, resulting in successful fistula takedown in 41 of 44 patients undergoing fistula resection. Three patients (5 per cent) died in hospital after reconstructive surgery. The overall mortality rate in this series, including preoperative deaths from underlying diseases, was 16 per cent (14 patients).
  
  
  CONCLUSIONS
  Intestinal failure care and reconstructive surgery resulted in successful discontinuation of PN in the majority of patients, although disease-related mortality was considerable.
authors.affiliation: Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Atema
authors.affiliation: Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Mirck
authors.affiliation: Departments of Endocrinology and Metabolism, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: I
authors.initials: I
authors.lastname: Van Arum
authors.affiliation: Departments of Dietetics, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: S M
authors.initials: SM
authors.lastname: Ten Dam
authors.affiliation: Departments of Endocrinology and Metabolism, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M J
authors.initials: MJ
authors.lastname: Serlie
authors.affiliation: Departments of Surgery, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Boermeester
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000401:mortality / Q000628:therapy*; D007422:Intestines; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome