[External fistulas of the small intestines in the newborn infant and child. Medical aspects and digestive resuscitation (19 cases)].
The prognosis in fistulae of the small intestine in the infant and child is totally different according to whether they develop following a simple operation involving the healthy small intestine or multiple or complicated operations on pathological bowel. Under these latter conditions, constant medico-surgical cooperation, modern techniques of renutrition (total parenteral renutrition or constant flow enteral nutrition), together with restoration of water/electrolyte balance and the treatment of infections give increasingly satisfactory results. In a series of 19 children, with 26 enterocutaneous fistulas, deaths were reduced to 4. Independently of recourse to surgery determined by local abdominal conditions (peritonitis, obstruction) or persistence of the fistula, the choice between total parenteral renutrition and constant flow enteral nutrition (C.F.E.N.) depend essentially upon the site of the fistula. When the latter is proximal the digestive tract may not be used, while C.F.E.N. may be employed when it is distal, sometimes resulting in cure without further surgery.