One hundred and fourteen fistulas of the gastrointestinal tract treated with total parenteral nutrition.

During a period of five years, all patients with fistulas of the gastrointestinal tract who received total parenteral nutrition as a part of the therapy were evaluated retrospectively. One hundred and eight patients with 114 fistulas of the gastrointestinal tract were studied. There were 58 male and 50 female patients. The mean age of the patients was 58 years old. Fifty-one per cent (58) of all fistulas resulted from surgical complications and 30 per cent from inflammatory disease. The most common origin of the fistula was the small intestine (48 per cent), with the large intestine being the next most common origin (26 per cent). Ninety-eight of the fistulas were treated successfully. The mean time for closure from the time of diagnosis was 30.9 days. Sixty-one per cent (69) of all fistulas closed spontaneously, the use of parenteral nutrition resolved 37 per cent (42) and 24 per cent (27) resolved after surgical control of sepsis. Twenty-five per cent (29) of the fistulas required definitive surgical closure. Sixteen patients died prior to resolution of the fistula, 11 deaths were directly related to septic complications of the fistula and one died as a result of hemorrhage of the fistula tract. The direct fistula-related mortality rate was 10.5 per cent. Whereas the mortality rate for fistulas remained stable, spontaneous closure rates continue to improve. This is attributed to improved "para-surgical" care, appropriate nutritional support and early and aggressive control of sepsis. Ninety to 95 per cent of fistulas that spontaneously resolve will do so within four to five weeks. Inflammatory disease of the intestine and radiation induced fistulas continue to respond poorly to medical management.