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.