Home Parenteral Nutrition: An Alternative Approach to the Management of Complicated Gastrointestinal Fistulas Not Responding to Conventional Medical or Surgical Therapy

Abstract

>Twelve patients, 9 with enterocutaneous fistulas and 3 with enterovaginal fistulas, were placed on a home parenteral nutrition (HPN) program after conventional inpatient total parenteral nutrition with bowel rest and/or surgical attempts at fistula closure failed. Fistula closure was achieved (in 66%) after from 28 to 400 days on the program. Six closed spontaneously while 2 were closed surgically. Underlying inflammation in the bowel and the persistence of fistula drainage beyond 180 days were indicative of a poor prognosis for closure. Number, location, and volume of drainage were not useful prognostic indices. HPN offers an alternative approach in the management of “intractable” gastrointestinal fistulas.

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