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clinmed/2003040003v1 (February 26, 2004)
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EARLY ENTERAL NUTRITION IN CASES OF PERFORATION OF THE GUT WITH PERITONITIS
AMBER MALHOTRA, and ASHOK. K MATHUR
Objective: To assess whether early postoperative nasogastric tube feeding in form of a balanced diet formula is safe and beneficial in patients of perforation of the gut (peptic ulcer perforations, enteric or typhoid perforations, traumatic perforations, tubercular and malignant perforations) even in presence of peritonitis.
Design: A Randomized control study on 200 operated patients of perforation of the gut with peritonitis. Nasogastric tube feeding of a balanced diet formula was begun on second postoperative day in randomly chosen patients. Comparisons were made with randomly chosen patients kept post operatively nil by mouth for five to seven days in a conventional regimen of management.
Setting: The study was carried out in one surgical unit of S.M.S Medical College Hospital.
Main outcome measures: Incidence and duration of the following: Wound infection, Wound dehiscence, Septicaemia, Intraabdominal sepsis, Pneumonia, Hospital stay & Mortality.
Tube feeding complications: Vomiting, Distension, Abdominal cramps, Diarrhoea, Leak of repaired perforation of the gut with peritonitis.
Biochemical measures: Haemoglobin, Serum albumin, Nitrogen balance, Blood urea, Serum creatinine.
Others: General well being, Wt.gain/Wt.loss.
Results: Most of the patients in the enterally fed group tolerated post-operative nasogastric tube feeding successfully from second post-operative day. The morbidity of wound complications, pneumonia, and septicaemia was significantly reduced in the enterally fed group. Though average hospital stay was no different from controls, the average loss of weight was minimal in the enterally fed patients who were also in a better nutritional state at the time of discharge.