Postoperative digestive fistulas associated with severe sepsis
V. Calu1, Mădălina Duţu2, Ioana Dumitrescu1, A. Miron1, Rely Manolescu2, Ş. Marinescu 2
1 Clinica Chirurgie, Spitalul Universitar de Urgenţă „Elias”, Bucureşti
2 Clinica ATI, Spitalul Universitar de Urgenţă „Elias”, Bucureşti
Abstract
Postoperative digestive fistulas are associated with high morbidity and mortality rates due to presence of sepsis, fluid and electrolytes imbalance and malnutrition leading to prolonged hospitalization and raised costs of medical care.
There are several factors influencing the morbidity rate and the spontaneous closure of digestive fistulas. To reveal the outmost importance of nutrition and prognosis factors for spontaneous closure of fistula we report two cases operated for bilio-pancreatic diseases, one female patient with scleroatrophic calculous cholecystitis complicated with internal biliary fistula and angiocholytis and one female patient with a pancreatic abcess after severe acute pancreatitis. Both developed in the postoperative period gastric fistula and underwent conservative treatment followed by spontaneous closure.
The principles of conservative treatment included: control of sepsis (adequate antibiotherapy), treatment of malnutrition and the decrease of fistula’s output by digestive rest and administration of H2 inhibitors, proton pump inhibitors and octreotide.
The presence of the unfavorable prognosis factors worsens the patient’s outcome with obvious implication in the treatment’s duration until complete healing: 4 days in the first case, comparing to 40 days in the second, which had severe sepsis associated. Altered status of the patients and the presence of comorbidities did not allow reoperation, conservative treatment being the single choice that led to the closure of the fistula and achievement of a good result.
Keywords: gastric fistula, sepsis, conservative treatment, nutritional support
J Rom Anest Terap Int 2010; 17: 55-60
CAZURI CLINICE
Fistulele gastrice postoperatorii asociate cu sepsis sever
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