2017 Volume 37 Issue 1 Pages 069-074
Case 1: A 78-year-old man was diagnosed as having perforation of a duodenal ulcer and retroperitoneal abscess. Conservative treatment by percutaneous drainage failed to yield improvement of the fistula. Case 2: A 40-year-old woman was diagnosed as having traumatic duodenal perforation caused by a traffic accident. Simple duodenal simple closure and omental patch closure were performed, however, leakage from the closure site and peritoneal abscess formation were observed. Therefore, both patients were transferred to our hospital for further treatment. Both received conservative treatment; in addition to drainage of the abscess, enteral nutrition was provided via a feeding tube that was guided caudally beyond the site of perforation. As a result, the abscess cavities shrank and the fistulae gradually closed, with improvement of the nutritional condition, in both patients. It is possible to guide a feeding tube caudally beyond the fistula site even in patients with upper gastrointestinal fistulae. We consider that enteral nutrition is effective for patients with upper gastrointestinal fistulae in terms of improving the nutrition status and reducing the invasiveness of treatment, and may serve as a good therapeutic alternative for patients with a poor performance status.
