Management of Post Necrosectomy Gastric Fistula by Nasogastric and Biliary Drainage with Transhepatic Distal Tube Feeding

Gastric fistula has been a relative common complication after bariatric surgery and surgery for necrotizing pancreatitis. Management of Upper GI fistula has changed over years and today a three phase approach which includes diagnosis and resuscitation with interval nutrition, drainage of collections and final definitive nutritional management with surgical correction, if required. Aggressive nutritional support to combat this catabolic state is most important for favorable outcome in these patients. Prolonged total parenteral nutrition has its known serious complications and naso gastric/jejunal feeds are also not always successful in patients with upperGl fistula. In such case we discuss here an alternative mode for distal feeding through transhepatic route which has shown acceptable results with fewer complications.