Management of Intestinal Failure: The High-Output Enterostomy and Enterocutaneous Fistula

Abstract

This article provides an overview of the pathophysiology, causes, investigations, and management of high-output enterostomy and enterocutaneous fistula. High-output stoma and enterocutaneous fistula can result in intestinal failure and this is often fatal if not managed properly. The management involves reducing fluid losses, providing nutrients with fluids, and treating the underlying cause and sepsis. A multidisciplinary approach is required for successful management of patients with high-output enterostomy and enterocutaneous fistula.

Keywords

intestinal failure - parenteral nutrition - enterostomy - short bowel syndrome - enterocutaneous fistula

• References

• 1 Pironi L, Arends J, Baxter J. , et al; Home Artificial Nutrition & Chronic Intestinal Failure; Acute Intestinal Failure Special Interest Groups of ESPEN. ESPEN endorsed recommendations. Definition and classification of intestinal failure in adults. Clin Nutr 2015; 34 (02) 171-180
• 2 Nightingale J, Woodward JM. ; Small Bowel and Nutrition Committee of the British Society of Gastroenterology. Guidelines for management of patients with a short bowel. Gut 2006; 55 (Suppl. 04) iv1-iv12
• 3 Gardiner KR. Management of acute intestinal failure. Proc Nutr Soc 2011; 70 (03) 321-328
• 4 Nightingale JMD. The medical management of intestinal failure: methods to reduce the severity. Proc Nutr Soc 2003; 62 (03) 703-710
• 5 Sica J, Burch J. Management of intestinal failure and high-output stomas. Br J Nurs 2007; 16 (13) 772-–777
• 6 Baker ML, Williams RN, Nightingale JMD. Causes and management of a high-output stoma. Colorectal Dis 2011; 13 (02) 191-197
• 7 Arebi N, Forbes A. High-output fistula. Clin Colon Rectal Surg 2004; 17 (02) 89-98
• 8 Scott NA, Leinhardt DJ, O'Hanrahan T, Finnegan S, Shaffer JL, Irving MH. Spectrum of intestinal failure in a specialised unit. Lancet 1991; 337 (8739): 471-473
• 9 Cataldo PA, MacKeigan JM. Intestinal Stomas: Principles, Techniques and Management. Oxfordshire, UK: CRC Press (Taylor and Francis); 2004
• 10 Sundaram A, Koutkia P, Apovian CM. Nutritional management of short bowel syndrome in adults. J Clin Gastroenterol 2002; 34 (03) 207-220
• 11 Baker ML, Nightingale JMD. Abnormal liver function test and parenteral nutrition. Clin Nutr 2004; 23: 864-865
• 12 Medlin S. Nutritional and fluid requirements: high-output stomas. Br J Nurs 2012; 21 (06) S22-S25
• 13 Reber HA, Roberts C, Way LW, Dunphy JE. Management of external gastrointestinal fistulas. Ann Surg 1978; 188 (04) 460-467
• 14 Lennard-Jones JE. Oral rehydration solutions in short bowel syndrome. Clin Ther 1990; 12 (Suppl A ): 129-137 , discussion 138
• 15 King RF, Norton T, Hill GL. A double-blind crossover study of the effect of loperamide hydrochloride and codeine phosphate on ileostomy output. Aust N Z J Surg 1982; 52 (02) 121-124
• 16 Newton CR. Effect of codeine phosphate, Lomotil, and Isogel on iileostomy function. Gut 1978; 19 (05) 377-383
• 17 Jeppesen PB, Staun M, Tjellesen L, Mortensen PB. Effect of intravenous ranitidine and omeprazole on intestinal absorption of water, sodium, and macronutrients in patients with intestinal resection. Gut 1998; 43 (06) 763-769
• 18 Farthing MJ. Octreotide in dumping and short bowel syndromes. Digestion 1993; 54 (1, Suppl 1): 47-52
• 19 Nightingale JM, Lennard-Jones JE, Walker ER, Farthing MJ. Jejunal efflux in short bowel syndrome. Lancet 1990; 336 (8718): 765-768
• 20 Woodcock N, MacFie J. Optimal nutrition support (and the demise of the enteral versus parenteral controversy). Nutrition 2002; 18 (06) 523-524
• 21 Woodcock N, MacFie J. Optimal nutritional support. Proc Nutr Soc 2004; 63 (03) 451-452
• 22 Lal S, Teubner A, Shaffer JL. Review article: intestinal failure. Aliment Pharmacol Ther 2006; 24 (01) 19-31
• 23 Braunschweig CL, Levy P, Sheean PM, Wang X. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr 2001; 74 (04) 534-542
• 24 Jeppesen PB. Teduglutide, a novel glucagon-like peptide 2 analog, in the treatment of patients with short bowel syndrome. Therap Adv Gastroenterol 2012; 5 (03) 159-171
• 25 Winkler MF, Smith CE. Clinical, social, and economic impacts of home parenteral nutrition dependence in short bowel syndrome. JPEN J Parenter Enteral Nutr 2014; 38 (1, Suppl): 32S-37S
• 26 Polk TM, Schwab CW. Metabolic and nutritional support of the enterocutaneous fistula patient: a three-phase approach. World J Surg 2012; 36 (03) 524-533
• 27 Slater R. High-output stomas: challenges with a large laparostomy wound. Br J Nurs 2012; 21 (06) S26 , S28–S33
• 28 Haack CI, Galloway JR, Srinivasan J. Enterocutaneous fistulas: a look at causes and management. Appl Phys B 2014; 2 (10) 1-10
• 29 Teubner A, Morrison K, Ravishankar HR, Anderson ID, Scott NA, Carlson GL. Fistuloclysis can successfully replace parenteral feeding in the nutritional support of patients with enterocutaneous fistula. Br J Surg 2004; 91 (05) 625-631
• 30 Coetzee E, Rahim Z, Boutall A, Goldberg P. Refeeding enteroclysis as an alternative to parenteral nutrition for enteric fistula. Colorectal Dis 2014; 16 (10) 823-830
• 31 Ferrone M, Scolapio JS. Teduglutide for the treatment of short bowel syndrome. Ann Pharmacother 2006; 40 (06) 1105-1109
• 32 Jeppesen PB, Lund P, Gottschalck IB. , et al. Short bowel patients treated for two years with glucagon-like peptide 2 (GLP-2): compliance, safety, and effects on quality of life. Gastroenterol Res Pract 2009; 2009: 425759
• 33 Naberhuis JK, Tappenden KA. Teduglutide for safe reduction of parenteral nutrient and/or fluid requirements in adults: a systematic review. J Parenter Enter Nutr 2016; 40 (08) 1096-1105