Early Enteral Nutrition in Cases of Perforation of the Gut with Peritonitis

Author(s): Siddarth Jain, Yogesh Kailasi, Ashutosh Garg, Shivam Patidar, Apoorvi Banerjee

Background: Gastro-duodenal perforation is a common surgical emergency requiring prompt surgical intervention, typically via omental patch repair. Traditional postoperative management involves delayed enteral nutrition to prevent stress on the gut; however, recent evidence supports early enteral feeding (EEF) to enhance recovery.

Objective: To evaluate the safety, feasibility, and outcomes of Early Enteral Feeding via nasojejunal (NJ) tube in patients undergoing surgery for gastro/duodenal perforation with peritonitis.

Methods: A prospective study was conducted on 50 patients diagnosed with gastrointestinal perforation and peritonitis, randomized into two groups: 25 received EEF (within 48 hours postoperatively via NJ tube), and 25 received Late Enteral Feeding (LEF) after return of bowel function (POD 6–8). Postoperative clinical and biochemical parameters were monitored on POD 3 and POD 7. Statistical analysis was performed using SPSS v20.

Results: The EEF group demonstrated significantly faster return of bowel function, reduced duration of ileus, and shorter hospital stays compared to the LEF group (p<0.05). Improvements in pulse rate, WBC count, serum albumin, and other vital parameters were observed earlier in the EEF group. The incidence of surgical site infection was lower in the EEF group (24% vs. 40%), although not statistically significant (p>0.05). No differences in mortality were observed between the groups.

Conclusion: Early enteral feeding via nasojejunal tube is a safe and effective strategy in patients with gastro/duodenal perforations. It accelerates recovery, reduces postoperative complications, shortens hospital stays, and is cost-effective without increasing mortality risk. Incorporating EEF into postoperative care protocols may enhance patient outcomes in emergency gastrointestinal surgeries.