Refeeding enteroclysis is feasible in selected patients with a proximal enteric fistula or stoma. Adequate nutrition, water and electrolyte balance can be achieved without resorting to parenteral infusions.

Case vignette A clinical entry, after specialist referral of a patient who experienced a postoperative troponin elevation, reads as follows: 'Thank you for the referral. Reason for referral: postoperative troponin elevation following total hip replacement. According to the history, the patient was asymptomatic and comfortable in the ward. No ischaemic symptoms or electrocardiogram [ECG] changes noted. Vital signs were within normal limits. Assessment: isolated troponin elevation, expected in this patient population and not clinically significant. Recommendation: review patient for symptoms, no specific therapy required. ' After an uneventful hospital stay, the patient was discharged on the 4th postoperative day, but died 5 days later at home. The global surgical volume has increased to >300 million proce dures per annum. [1] Cardiovascular complications contribute to onethird of major perioperative morbidity and mortality, with perioperative myocardial infarction and myocardial injury after noncardiac surgery (MINS) accounting for 39% of all deaths within 30 days of noncardiac surgery. [2] These deaths are distributed equally between patients who sustain a postoperative myocardial infarction and MINS. [2] The burden of perioperative cardiovascular complications, therefore, has a major public health importance. The paucity of clinicians with an appreciation of the importance of perioperative myocardial injuries and the associated prognosis, and the knowledge necessary to manage this public healthcare burden, needs to be addressed. [3] Methods A literature search on MINS in the perioperative period was conducted using MEDLINE and the following search terms: 'myocardial injury' , 'noncardiac surgery' , 'mortality' , 'perioperative complications' , 'treatment' , 'prevention' and 'guidelines'. Additional reports were obtained by reviewing reference lists from the literature. Studies involving large cohorts with clear inclusion criteria and outcome data were reviewed. Reviews and smaller studies with local significance were also included. This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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