[Treatment of external postoperative fistulas of the gastrointestinal tract].

In the years 1985-1996 82 patients with postoperative external fistulas of gastrointestinal tract (pefgt) were treated in the Department of General Surgery of Hospital in Olsztyn. The age of the patient varied from 18 to 70 years. 37 patients were women and 45 man. Volume of excreted fluid fluctuated from 100 ml to 3000 ml per day. The most frequent cause of pefgt was dehiscence of the anastomosis of jejunum in 31 patients, and operations of complications of gastric or duodenal ulcer disease in 30 patients. 54 patients underwent medical treatment. It was based on compensation of disorders in water and electrolyte balance and acid-base equilibrium, nutritional treatment, protection of the skin, suction of the excreted fluid, controlling of foci of infection, rehabilitation. 7 patients were reoperated for the purpose of closing the fistula and 21 to drain abscess or to stop bleeding. 57 (70%) out of 82 patients recovered, 25 (30%) died. In this number 14 patients among 54 treated conservatively and 11 out from 28 operated. The most frequent cause of death was sepsis (15 patients). The conservative treatment including TPN is successful in majority of patients with pefgt and indispensable in patients treated operatively. Special attention should be given for coexisting intraperitoneal abscessa, peritonitis and sepsis.