Reinfusion Enteroclysis Can Successfully Replace Parenteral Feeding in Patients with High-Output Enteral Fistula or Ostomy Awaiting Definitive Surgery

Abstract

Distal bowel reinfusion enteroclysis or fistuloclysis or mucous fistula re-feeding is described as the method of collecting proximal bowel effluents and re-infusing the same into the distal viable bowel with or without effluent processing. Patients with anatomical or functional short bowel syndrome (SBS) are very difficult to manage with great risk of fluid electrolyte imbalance and protein calorie malnutrition. We describe our experience with reinfusion of stoma effluent in these patients, whether it can be used as a stand-alone modality after an initial bridging period of total parenteral nutrition therapy (TPN). Reinfusion enteroclysis was attempted in 30 patients with functional SBS but with distal viable continuous bowel. After an initial bridging period of TPN therapy, gradually increasing quantities of chyme reinfusion was done with a Foley’s catheter in the distal bowel until the whole of daily requirements was met by oral feeds and reinfusion enteroclysis. Gradually, the parenteral nutrition (PN) was withdrawn. Daily assessment of patient’s oral nutritional adequacy, fluid, and electrolyte balance was done while in the hospital. Patients who were nutritionally stable on exclusive enteroclysis were discharged and were kept on stand-alone “home enteroclysis.” The patients were followed until definitive surgery. Even though median length of proximal bowel was just 40 cm from duodeno-jejunal junction, PN could be completely withdrawn in 24 patients; they sustained only on reinfusion enteroclysis. Eighteen patients were discharged and sustained independently on “home enteroclysis.” All 30 attained a positive nitrogen balance with weight gain and increasing albumin titers. There were no complications associated to reinfusion and no associated mortality. Successful definitive surgery was carried out in 16 patients, within the 3-month study period. However, 14 patients required more than 3 months for their definitive surgery. During this period, 8 of them continued to be on “exclusive re infusion enteroclysis” and 6 on a combination of PN and reinfusion enteroclysis until the second stage of definitive operative intervention. Reinfusion enteroclysis/fistuloclysis can act as effective stand-alone nutritional therapy in selected patients and adjunctive therapy in all patients of functional SBS with distal viable continuous bowel.