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Enterocutaneous fistulas of the small bowel in children (25 cases)
Insights
Nutritional support significantly improved outcomes for children with severe enterocutaneous fistulas. Non-surgical management, including total parenteral nutrition, led to successful closure in most cases, reducing the need for surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nutritional Support
Background:
- Enterocutaneous fistulas are a serious complication in children.
- Historically, surgical intervention was the primary treatment for these fistulas.
Purpose of the Study:
- To evaluate the effectiveness of non-surgical management for pediatric enterocutaneous fistulas.
- To assess the impact of nutritional support on treatment outcomes.
Main Methods:
- Retrospective analysis of 25 pediatric cases over 5 years.
- Initial non-surgical treatment including total parenteral nutrition or enteral feeding.
- Associated local wound care.
Main Results:
- Two deaths occurred in 25 patients.
- 13 out of 25 cases achieved successful closure without surgery.
- 9 out of 11 secondary operations were successful.
- Non-surgical management was the initial approach in 24 cases.
Conclusions:
- Nutritional support, including total parenteral nutrition and enteral feeding, has dramatically improved the prognosis for pediatric enterocutaneous fistulas.
- Non-surgical management is a viable and effective primary treatment strategy.
- This approach reduces the need for surgical intervention and improves patient outcomes.
Abstract:
During the past 5 yr, 25 children ranging in age from 10 days to 14 yr have been treated for single or multiple severe enterocutaneous fistulas. There were two deaths. In 24 cases out of 25, initial treatment was nonsurgical and consisted of nutritional support (by total parenteral nutrition in 20, and constant rate enteral feeding in 4) and was associated with local treatment. Successful closure was achieved without surgery in 13 cases, and 11 secondary operations were performed, with success in 9. The addition of nutritional methods has completely changed the prognosis of enterocutaneous fistula.