Nutritional management of gastroenterocutaneous fistulas

Albert Chi, Michael Ditillo

Research output: Chapter in Book/Report/Conference proceedingChapter


Despite significant improvements in medical and surgical treatments of gastroenterocutaneous fistulas (ECFs), they remain a significant cause of morbidity and mortality for patients who develop them. A hypermetabolic response and profound disturbances in fluid and electrolyte levels, leading to dehydration, hyponatraemia, hypokalemia, and metabolic acidosis, are common, making this patient population a unique subgroup of critically ill patients vulnerable to further decline in nutritional status. In general, medical treatment and stabilization precede attempts at surgical intervention and remain a hallmark of therapy for ECFs. The most challenging aspect of ECF management is nutritional repletion because there is no standard protocol, and each patient and case is unique. The management requires patient- as well as fistula-specific factors to be considered for optimizing the best treatment regimen. Currently, there are no well-established, evidence-based clinical guidelines for managing the medications and nutrition care of these patients. Although it is often difficult and sometimes impossible to provide adequate enteral nutrition in the presences of an ECF, nutritional support should be implemented whenever possible. Many questions have been answered; however, there is no uniformity to these answers. This chapter reviews the roles of enteral and supplemental parenteral nutrition, somatostatin, and immune-modulating nutritional supplementation.

Original languageEnglish (US)
Title of host publicationSurgery of Complex Abdominal Wall Defects
PublisherSpringer New York
Number of pages4
ISBN (Electronic)9781461463542
ISBN (Print)9781461463535
StatePublished - Jan 1 2013
Externally publishedYes


  • Enteral nutrition
  • Fistula
  • Gastro-enterocutaneous fistula
  • Glutamine, arginine
  • Malnutrition
  • Micronutrients, trace elements
  • Octreotide
  • Total parenteral nutrition

ASJC Scopus subject areas

  • General Medicine


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