Verma, G RKaman, LileshwarSingh, GurpreetSingh, RajinderBehera, ArunanshuBose, Shashank Mohan2006-01-292009-05-292006-01-292009-05-292006-01-29Verma GR, Kaman L, Singh G, Singh R, Behera A, Bose SM. External duodenal fistula following closure of duodenal perforation. Indian Journal of Gastroenterology. 2006 Jan-Feb; 25(1): 16-9http://imsear.searo.who.int/handle/123456789/64047AIM: Retrospective analysis of experience with management of external duodenal fistula (EDF) without using total parenteral nutrition (TPN). METHOD: Medical records of 31 patients with EDF following closure of duodenal ulcer perforation, treated over a 7-year period (1994-2001), were studied. Twenty-one patients (68%) had evidence of sepsis at presentation or during the course of treatment. None could afford TPN for optimum time. All patients received hospital-based enteral nutrition through nasojejunal tube, besides supportive medical treatment and/or surgery. Peritonitis or failure to insert nasojejunal tube for enteric alimentation led to early surgery. RESULTS: Two patients died of septicemia and multi-organ failure within 48 hours of admission. Fourteen patients (48.3%) initially received conservative treatment (Group I); six of them later required surgery. Fifteen patients (51.7%) underwent early surgery due to peritonitis (n=9) or failure to establish enteral feeding (n=6) (Group II); wound infection, intra-abdominal abscess and septicemia were more common in these patients than those in Group I. Survival rate was higher in Group I than in Group II (86% versus 40%; p< 0.05). Septicemia and gastrectomy were the independent factors associated with high mortality. CONCLUSIONS: EDF can be satisfactorily managed without TPN. Successful placement of enteral feeding line, supportive treatment and delayed surgery can achieve survival in 85% of patients. Minimum intervention is recommended when early surgery is performed in peritonitis or to establish enteral feeding line.engAdultAgedDuodenal Ulcer --surgeryFemaleHumansIntestinal Fistula --etiologyIntestinal Perforation --surgeryLogistic ModelsMaleMiddle AgedRetrospective StudiesSurvival RateTreatment OutcomeJournal Article