ISCHEMIC NECROTIC BOWEL-DISEASE IN THERMAL-INJURY

Background: Gastrointestinal tract (GI) complications are a well-recog nized entity following burn injury. Objectives: To determine whether t here was a change in the incidence and type of GI complications in ind ividuals with thermal injuries requiring operative intervention and wh ether this might be related to changes in patient management. Design: A retrospective 8-year study of patients admitted with burn injuries. Setting: A university medical center burn unit. Methods: Statistical a nalysis and pathological review of 2 groups of patients: those with is chemic necrotic bowel disease (INBD group) and those with other GI com plications (other GI complication group), identified among 2114 patien ts admitted with burn injuries during an 8-year period (1988-1995). Re sults: Of 2114 patients admitted with burn injuries, 19 patients were identified retrospectively as having had either INBD (n=10) or other G I complications (n=9). Statistical analysis showed no difference betwe en the 2 groups in duration of hospitalization, age, sex, pneumonia, m ortality, peritonitis or gastric ulcer disease, inhalation injury, ven tilator use, grafting procedures, or infections. The patients in the I NBD group had a statistically significant mean (+/-SD) increase in the percentage of total burn surface area compared with those in the othe r GI complication group (53%+/-10% vs 22%+/-7%; P<.02) and sepsis prio r to the GI complication (32% vs 5%; P<.03). A statistically significa nt decrease was noted in the incidence of paralytic ileus (17% vs 69%; P<.03). Enteral nutritional support became the primary mode of treatm ent, and GI hemorrhage and ulcer disease decreased during this period. Patients with total burn surface area greater than 40% and sepsis wer e at increased risk of INBD during their hospitalization. Conclusions: The severity of thermal injury and systemic infection are risk factor s for the development of INBD. This entity is more frequent currently because of increased survival of the more severely injured patients. S ystemic infection may alter the integrity of the bowel, which becomes less ''tolerant'' of enteral feedings. The role of large-volume high-d ensity enteral feedings as a usually associated event in these patient s remains speculative.