The treatment of high intestinal fistulas is a serious problem because of the interference with fluid and mineral balance and because the distressing digestion of the wound margin and skin surface delays healing, interferes with the patient's rest and causes him to refrain from eating. He soon learns that ingestion of food is followed by secretion of digestive juices, which reach the abdominal surface and cause intolerable distress. The problem to be discussed here is not the replacement of the lost fluid and solutes, although that may be vital in cases in which the loss is almost complete.1
Efforts to control the digestion of the abdominal wall have been only partly successful. They have been based on three main principles:2 (1) the chemical neutralization of tryptic ferments by combining them with an excess of peptone powder, protein and fat;3 (2) adsorption of the ferments by finely divided charcoal or
Straus FH. PREVENTION OF SKIN DIGESTION IN HIGH INTESTINAL FISTULAS. JAMA. 1935;105(17):1345. doi:10.1001/jama.1935.92760430001010
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