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Parenteral nutrition
PMO-064 Can intestinal failure due to fistula be managed safely out with the national centres?
  1. M Quinn,
  2. S Falconer,
  3. R Mckee
  1. Department of Colorectal Surgery, Glasgow Royal Infirmary, Glasgow, UK

Abstract

Introduction Type II Intestinal Failure (IF) requires multidisciplinary management at significant cost. Up to 50% of these patients will progress to home parenteral nutrition (PN). The aim of this study was to assess the outcomes of patients with type II intestinal failure due to small bowel fistulae in a tertiary referral centre and compare these with published data.

Methods Patients were identified from a prospectively collected database (January 1998–December 2009). Data were analysed retrospectively. Data were split into groups by diagnosis: Acute pancreatitis, Upper Gastrointestinal, Colorectal, Hepatobiliary, Inflammatory Bowel Disease (IBD) and “other” (trauma, mesenteric ischaemic, failed PEG/PEJ, vascular, gynaecology). Data were analysed using SPSS V.17.1; Pearson χ2 test and ANOVA, p=0.05 denoting significance.

Results 190 fistulas in 186 patients (median age 64 years (20–96), M:F 103:83) required PN. 75 (39.5%) developed following emergency admission, 63 (32.2%) following elective admission and 52 (27.4%) were in patients transferred from other hospitals because of the fistula. 160 (84.2%) fistulas developed following surgery. Patients undergoing major HPB procedures were statistically more likely to develop a post-op fistula (p=0.031). 113 (59.5%) fistulas settled with conservative treatment. 34 (18%) patients died before any surgery. Overall mortality was 21% (39 of 186 patients). Patients with HPB pathology or those transferred from other hospitals were statistically more likely to die as a result of their fistula (p=0.007). Patients with IBD, colorectal pathology and those transferred from other hospitals were more likely to require surgical intervention for their fistula (p=0.007). Patients in the “other” diagnosis category were statistically more likely to require a definitive operation (p=0.02). 11 fistulas required early open operation within 1-month. One due to underlying malignancy and ten to control sepsis. Following early operation one patient died, two required permanent home PN and five settled after open drainage of sepsis only. Two patients went on to further definitive surgery. 30 definitive operations were performed. Post operatively, four patients died, two required permanent HPN and three fistulas recurred in two patients, one of whom required further surgery.

Conclusion Reasonable outcomes from intestinal failure can be achieved out with the national referral services but a significant amount of resource is needed, including a multidisciplinary nutrition team, interventional radiology and a surgical team accustomed to dealing with such cases.

Competing interests None declared.

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