Question 18.



A 50 year old man underwent a laparotomy for intestinal obstruction. Seven days postoperative, it was noted that small bowel contents were discharging through one of the abdominal drain sites. Over the next 48 hours, daily measured volume from the small bowel fistula was 2500 ml/day. Meanwhile a regimen of nil orally, nasogastric suction was maintained.a. In relation to replacement therapy, what type of fluid should be used? (1 mark)

b. In addition to the fistulous loss, what other sources of fluid volume losses should be considered? (2 marks)

c. To achieve spontaneous (non-operative) closure of the fistula, what factors pertaining to the fistula itself should be excluded? (5 marks)

d. Waht other supportive therapy would you consider to maximise healing of the fistula? (2 marks)