Wang Xiao-Tong, Wang Long, Liu An-Lin, Huang Jing-Le, Li Lei, Lu Zhi-Xing, Mai Wei
Departments of Gastrointestinal, Hernia and Enterofistula Surgery, People's Hospital of Guangxi Zhuang Autonomous Region & Institute of Minimally Invasive Technology and Applications, Nanning 530021, Guangxi Zhuang Autonomous Region, China.
World J Clin Cases. 2024 Jul 16;12(20):4384-4390. doi: 10.12998/wjcc.v12.i20.4384.
Enterocutaneous fistula (ECF) is an abnormal connection between the gastrointestinal tract and the skin. ECF can lead to massive body fluid loss, hypercatabolism, and malnutrition. Therefore, nutritional support plays a crucial role in managing ECFs and promoting the healing of fistulas. For nutritional support, enteral nutrition (EN) is the preferred method when gastrointestinal function is recovering. Currently, various EN approaches have been applied for different anatomical positions of the ECF. However, the effectiveness of administering EN support for treating lower ECFs still needs further exploration and improvement.
We present the case of a 46-year-old male who underwent gastrointestinal stromal tumour resection. Six days after the surgery, the patient presented with fever, fatigue, severe upper abdominal pain, and septic shock. Subsequently, lower ECFs were diagnosed through laboratory and imaging examinations. In addition to symptomatic treatment for homeostasis, total parenteral nutrition support was administered in the first 72 h due to dysfunction of the intestine. After that, we gradually provided EN support through the intestinal obstruction catheter in consideration of the specific anatomic position of the fistula instead of using the nasal jejunal tube. Ultimately, the patient could receive optimal EN support the catheter, and no complications were found during the treatment.
Nutritional support is a crucial element in ECF management, and intestinal obstruction catheters could be used for early EN administration.
肠皮肤瘘（ECF）是胃肠道与皮肤之间的异常连接。ECF可导致大量体液丢失、高分解代谢和营养不良。因此，营养支持在ECF的管理和促进瘘管愈合中起着关键作用。对于营养支持，当胃肠功能恢复时，肠内营养（EN）是首选方法。目前，针对ECF的不同解剖位置已应用了各种EN方法。然而，给予EN支持治疗低位ECF的有效性仍需进一步探索和改进。
我们报告一例46岁男性患者，该患者接受了胃肠道间质瘤切除术。术后6天，患者出现发热、乏力、严重上腹痛和感染性休克。随后，通过实验室和影像学检查诊断为低位ECF。除了进行维持内环境稳定的对症治疗外，由于肠道功能障碍，在最初72小时给予了全胃肠外营养支持。之后，考虑到瘘管的具体解剖位置，我们通过肠梗阻导管逐渐提供EN支持，而不是使用鼻空肠管。最终，患者通过该导管获得了最佳的EN支持，治疗期间未发现并发症。
营养支持是ECF管理的关键要素，肠梗阻导管可用于早期给予EN。
