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Nutrition in Clinical Practice
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Clinical Observations

Fistuloclysis: Case Report and Literature Review

Maggie Ham, MD*, Kelli Horton, RD, CNSD{dagger} and Jonathan Kaunitz, MD{dagger},{ddagger}

* School of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California;{dagger} Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; and the{ddagger} Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California

Correspondence: Jonathan Kaunitz, MD, UCLA School of Medicine, Bldg 114/Room 217E, 11301 Wilshire Blvd, Los Angeles, CA 90073. Electronic mail may be sent to jake{at}ucla.edu.

Enterocutaneous fistulae are a common postoperative entity, causing serious complications such as sepsis, malnutrition, and electrolyte and fluid abnormalities. Because sepsis coupled with malnutrition is the leading cause of death in these patients, it is especially important to provide nutrition support. Although parenteral nutrition (PN) is widely used in these patients, it is not without risks, because PN is known to cause liver dysfunction, among other problems. We report a case in which a male patient with an enterocutaneous fistula, having experienced increased liver enzymes receiving PN, began receiving enteral nutrition (EN) via a feeding tube placed in the fistula. Known as fistuloclysis, this method provided adequate nutrition and improved his serum albumin and prealbumin levels, body weight, and liver function tests. Upon stabilization of his nutrition status, he was able to undergo successful surgical repair of the enterocutaneous fistula. According to our experience and that of others, we recommend that patients with high-output enterocutaneous fistulae be considered for EN via fistuloclysis after nutrition stabilization with PN; then the fistulae can be surgically repaired if not spontaneously healed. Use of EN via fistuloclysis, if used appropriately, avoids the complications of long-term PN and may promote faster fistula healing.

Nutrition in Clinical Practice, Vol. 22, No. 5, 553-557 (2007)
DOI: 10.1177/0115426507022005553
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