[Value of octreotide in the treatment of postoperative enterocutaneous fistula]

Two patients with enterocutaneous fistulas (ileal and duodenal) were successfully treated with bowel rest, total parenteral nutrition and the somatostatin analogue octreotide (150 micrograms.day-1 and 300 micrograms.day-1 respectively). At the time octreotide was started the first patient had a high output fistula (1 000 mL.day-1), the second had a low output fistula (120 mL.day-1). Within 24 hours of treatment, a reduction of at least 40% of the output was observed. The time intervals to fistula closure were respectively 6 days and 10 days after initiation of octreotide therapy. Glucose intolerance was not observed. The efficacy of octreotide combined with total parenteral nutrition supports its routine use instead of somatostatin, more expensive, less tolerated and presenting the risk of rebound effect.