Catastrophic enterocutaneous fistulae

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Home hyperalimentation in the treatment of patients with an inadequately functioning gastrointestinal tract has been reported by several authors.1–8 The indications for its use include massive bowel resections for vascular compromise, bowel obstruction, inflammatory disease, tumor, and volvulus. Home hyperalimentation has been also used for functional short bowel syndrome caused by inflammatory bowel disease or radiation enteritis.

We report three cases in which home hyperalimentation has been employed as a temporary but prolonged measure in the management of catastrophic high output enterocutaneous fistulae.

Case reports

Case 1. A 16-year-old boy had a history of colitis since the age of 4½ years. This had been treated intermittently with salicylazosulfapyridine (Azulfidine) and steroids and became more severe in 1973; the colitis gradually worsened. In December 1975 the patient was admitted to a local hospital with toxic megacolon and a free perforation at the splenic flexure. On December 20, 1975, a proctocolectomy and ileostomy were performed. Postoperatively a high fever developed and at reexploration on January 5, 1976, multiple intraabdominal abscesses were found, including left subphrenic and left subhepatic abscesses. These were drained. Shortly after operation, almost total drainage of his fecal stream through the perineal wound occurred, together with persistent purulent drainage from the upper abdominal drain sites. His general condition deteriorated and he was transferred to The Cleveland Clinic Foundation on January 19, 1976.

On admission to the Cleveland Clinic Hospital, he was pale, thin, and cachectic; he weighed 53.5 kg (118 pounds); normal weight, 81.7 kg (180 pounds). He . . .



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