Metabolic and nutritional management of a patient with multiple enterocutaneous fistulas

Abstract

The patient is a 26-y-old male who sustained a close-range shotgun wound to the perineum. Following resuscitation at a community hospital in which an exploratory laparotomy with sigmoid loop colostomy was performed, he was transferred to a tertiary referral trauma center. Upon re-exploration, there was no evidence of viable rectum, and the wound was approximately lo- 14 cm in depth and extended from the base of the scrotum to the sacrum. Following several debridements, he was left with an end sigmoid colostomy with the open perineal and abdominal wounds to heal by secondary intention. Postoperatively, the patient’s stay was complicated by the development of multiple enterocutaneous fistulas all confined to the right lower quadrant. Initially these were treated conservatively with control of drainage, octreotide acetate, non per OS (NPO), and total parenteral nutrition (TPN) for nutritional support. Once stable he underwent split-thickness skin graft to his abdominal wounds following a brief course of human recombinant growth hormone (GH) in hopes of enhancing development of granulation tissue of the grafting bed.