Nutrition in the surgical patient is a multifactorial, complex subject. Beyond the decision to feed enterally or parenterally, a surgeon must consider specific patient characteristics that interfere with the delivery of nutrients for useful and purposeful digestion and metabolism. Certainly the patient with postoperative ileus, a previous bowel obstruction, short gut, the trauma open, damage-controlled abdomen, or discontinuous bowel, to mention only a few special circumstances, has energy requirements beyond what is provided by maintenance or resuscitative fluids, and these examples comprise situations in which early feeding would inherently be of benefit. Certainly the patient with fistulization to the skin deserves focused discussion as this patient population, more than the standard surgical patient or the disaster, damage-controlled abdomen, has the additional complexity of nutrient and digestive component loss.
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