EARLY POSTOPERATIVE ENTERAL FEEDING IN PATIENTS WITH NONTRAUMATIC INTESTINAL PERFORATION AND PERITONITIS

Background: In our clinical setting, patients with perforative periton itis are frequently malnourished. Immediate postoperative enteral feed ing has been shown effective in reducing septic morbidity in patients with abdominal trauma. This study was designed to investigate the feas ibility and efficacy of immediate postoperative enteral feeding in pat ients with nontraumatic intestinal perforation and peritonitis. Study Design: A prospective study spanning 1 year was conducted on patients with nontraumatic intestinal perforation and peritonitis. After laparo tomy, patients were assigned randomly to a control or study group. The study group underwent a feeding jejunostomy and received enteral feed ing from 12 hours postoperatively. A low-residue, milk-based diet was used. All patients underwent assessment for severity of sepsis and nut ritional status at admission. Studies of nutritional status and nitrog en balance were repeated on days 4 and 7. Results: Forty-three patient s (21 in the study group; 22 in the control group) were included. The two groups were comparable except for a higher sepsis score in the stu dy group (p < 0.05). Patients in the study group achieved a positive n itrogen balance by the third postoperative day; patients in the contro l group remained in negative nitrogen balance throughout the study. Ab dominal distention (four patients) required temporary withdrawal of fe eding. Diarrhea occurred in four patients but was controlled easily. T he mortality rate was similar in the control and study groups (18.2% v ersus 19.1%). The control group had a total of 22 septic complications , versus eight in the study group (p < 0.05). Conclusions: Immediate p ostoperative feeding is feasible in patients with perforative peritoni tis and reduces septic morbidity. (J Am Coll Surg 1998;187:142-146. (C ) 1998 by the American College of Surgeons)