Conservative treatment of gastrointestinal fistulas

Conservative measures were instituted as the primary treatment of 39 consecutive patients with high output fistulas of the gastrointestinal tract and related organs. Nutritional status was maintained by an intravenous feeding regimen, using peripheral vein infusion sites and supplying 60% of the calorie intake by a fat emulsion. This regimen had no serious complications. These patients died during treatment. The fistulas healed spontaneously in 35 of the remaining 36 patients. None of these patients had obstruction distally or other factors tending to prevent spontaneous closure. Under these circumstances, nonoperative treatment is safest and best. Surgical closure was necessary in one patient after two months of conservative treatment and was successful.