Detection, prevention and treatment of enteral dysfunction in fulminant acute pancreatitis

Objective Enteral nutrition has been proved to be effective in preventing bacterial translocation and consequential infectious complications by maintaining the integrity of mucosal barri-er, but improper use of EN might aggravate the disease. However serious gastrointestinal dysfunction and MODS occurs simultaneously in the early stage of FAP, and the value and feasibility of EN appli-cation remains controversy. Methods An observational study of FAP patients was carried out from Jan 1st 2006 to Dec 31st 2007 in Ruijin hospital. Tolerance to early EN, MODS, early etiological treat-ments, early surgical treatments and prognosis of the patients were observed and analyzed. Results Among 13 patients tolerant to EN, 10 recovered. In 4 who were intolerant to enteral nutrition, 2 re-covered. Three out of 4 with multiple organ dysfunction in the early course of the disease were tolerant to enteral nutrition, while 10 out of 14 with single organ dysfunction were tolerant to it. All of 8 pa-tients underwent early etiological treatments were tolerant to enteral nutrition, but only 5 out of 9 pa-tients without early etiological treatments were tolerant to it. Conclusion Parallel treatment strategy concerning shock and gastrointestinal dysfunction simultaneously should be carried out for FAP, as is for remote MODS and ACS. The patients can be benefited from proper fluid resuscitation, early etio-logical treatment, dynamic detecting of intra-abdominal pressure and prompt decompression of the lesser omentum and the retroperitoneum, which may improve the feasibility of application of enteral nutrition and aid the patients to recover. Key words: Pancreatitis;  Multiple organ dysfunction;  Gastrointestinal dysfunction;  En-teral nutrition;  Parallel treatment strategy