C L Scaife1, J R Saffle, S E Morris. 1. Department of Surgery and the Intermountain Burn Center, University of Utah Hospitals and Clinics, Salt Lake City 84132, USA.
Abstract
BACKGROUND: Enteral feeding is preferred for maintaining gut integrity and providing nutrition in trauma patients. Recent reports suggest that use of early enteral feeds is successful and that complications are rare. A recent burn patient, who suffered apparent bowel obstruction and perforation secondary to enteral feedings, led us to review our experience with mechanical complications of tube feedings. METHODS: We searched our registry of patients treated for acute burn trauma injury and identified patients treated for acute bowel obstruction in the past 3 years. RESULTS: Four patients were identified, ages 22 to 44, with burns of 6 to 92% total body surface area. Each required intubation and ventilatory support during initial treatment, complicated by adult respiratory distress syndrome and sepsis. We began enteral feeds 1 to 3 days after admission. At approximately 14 days after admission, each patient deteriorated clinically, which led to emergent abdominal exploration; the tube feedings caused bowel obstruction and associated complications. Each patient improved with laparotomy. CONCLUSION: Bowel obstruction, ischemic necrosis, or both, secondary to early and aggressive nutrition with a fiber supplemented enteral feeding is an uncommon, life-threatening complication. Understanding and early recognition of this potential complication are essential to prevention or successful treatment.
BACKGROUND: Enteral feeding is preferred for maintaining gut integrity and providing nutrition in traumapatients. Recent reports suggest that use of early enteral feeds is successful and that complications are rare. A recent burn patient, who suffered apparent bowel obstruction and perforation secondary to enteral feedings, led us to review our experience with mechanical complications of tube feedings. METHODS: We searched our registry of patients treated for acute burn trauma injury and identified patients treated for acute bowel obstruction in the past 3 years. RESULTS: Four patients were identified, ages 22 to 44, with burns of 6 to 92% total body surface area. Each required intubation and ventilatory support during initial treatment, complicated by adult respiratory distress syndrome and sepsis. We began enteral feeds 1 to 3 days after admission. At approximately 14 days after admission, each patient deteriorated clinically, which led to emergent abdominal exploration; the tube feedings caused bowel obstruction and associated complications. Each patient improved with laparotomy. CONCLUSION:Bowel obstruction, ischemic necrosis, or both, secondary to early and aggressive nutrition with a fiber supplemented enteral feeding is an uncommon, life-threatening complication. Understanding and early recognition of this potential complication are essential to prevention or successful treatment.
Authors: Thu An Nguyen; Yasmine Ali Abdelhamid; Liza K Phillips; Leeanne S Chapple; Michael Horowitz; Karen L Jones; Adam M Deane Journal: World J Crit Care Med Date: 2017-02-04
Authors: Grazia Leonello; Antonio Giacomo Rizzo; Viviane Di Dio; Antonio Soriano; Claudia Previti; Grazia Giulia Pantè; Claudio Mastrojeni; Sebastiano Pantè Journal: Int Med Case Rep J Date: 2018-04-09