To evaluate the effectiveness of treatment with total parenteral nutrition (TPN) alone (group A) or combined with continuous intravenous infusion of somatostatin (group B) in postoperative gastrointestinal fistulas, a multicenter, controlled and prospective randomized trial was designed. We present the results obtained after the evaluation of 40 cases (group A, n = 20; group B, n = 20). No significant differences among these treatment schedules were observed in the percentage of closure of fistulas (group A, 81.25%; group B, 85%), but patients treated with total parenteral nutrition plus somatostatin had the fistulas close within a significantly shorter period of time. Moreover, this treatment was associated with a significantly lower morbidity. These preliminary results indicate that somatostatin is a useful therapeutic complement in the conservative treatment of patients with gastrointestinal fistulas.

Background: Gastrointestinal fistulas are a serious complication of gastrointestinal tract surgery: they are often accompanied by high levels of morbidity and mortality. Among other things, some fistula characteristics (anatomical site, type of tract, time elapsed to fistula appearance and volume of output) are being considered as of great importance. New therapeutic approaches such as somatostatin are nowadays being tested in order to clarify the benefits of its use. Merhod: A multi-centre, randomized, controlled and prospective trial was carried out (n = 40, March-December, 1988) to evaluate the effectiveness of total parenteral nutrition (TPN) versus TPN + somatostatin in the conservative management of postoperative gastrointestinal fistulas. Since January 1989, wider inclusion criteria have been followed, and all patients ( n = 63) who have fulfilled inclusion criteria have been admitted to TPN plus somatostatin treatment. Results: Closure time of fistulas in patients receiving TPN + somatostatin was significantly shorter (13.86 f 1.84 versus 20.4 2 2.89 days) than in those receiving TPN alone. In the second phase of the study, more time was needed to obtain complete closure of fistulas (15.8 days). Conclusion: Somatostatin is a useful therapeutic complement in the management of postoperative gastrointestinal fistulas, since it accelerates their spontaneous closure. Complex tract Gross (over 1 ,OOO ml/d) leakage Severe metabolic disorders (diabetes. . .) Relative Scand J Gastroenterol Downloaded from informahealthcare.com by Thomas Jefferson University on 12/26/14 For personal use only. 11. Kaminski VM, Deitel M. Nutritional support in the management of external fistulas of the alimentary tract. Br J Surg 1975;62: 100-3. 1972; 123 13 17-22. Scand J Gastroenterol Downloaded from informahealthcare.com by Thomas Jefferson University on 12/26/14For personal use only.

Retrograde injection of 5% sodium taurocholic acid (TA) in Wistar rat pancreatic duct is followed by acute pancreatitis, resulting in 100% mortality within 36 h. Biochemical determinations show raised levels of amylase in ascites and blood. Necrosis has been measured using seven morphometric characteristics of pathological changes that add precise information on the type and extension of the pancreatic lesion. The percentage of necrotic tissue (by area) seems to be the most objective parameter. Necrosis appears 6 h after TA infusion, being 5.77% in extent after 12 h, 14.9% after 24 h and animals die with an area of 29.5% necrosis. This experimental model seems to one in which physiopathological and therapeutic trials on acute pancreatitis may be tried out.

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