Traumatic pancreatic cutaneous fistula: comparison of enteral and parenteral feedings.

A patient with a gunshot injury to the duct of Wirsung in the pancreatic head developed a high-output pancreatic cutaneous fistula. Before operative repair, a 2-month period of nutritional support permitted a comparison of different feeding regimes. Elemental jejunal feedings containing 1-amino acids in a low-fat, hyperosmolar formula were associated with no greater fistula volume output than total parenteral nutrition. In addition to this efficacy in controlling pancreatic exocrine activity, elemental jejunal feedings were less than a third as expensive as parenteral nutrition.