Unusual techniques in the management of enteroatmospheric fistula. Report of a case

AbstractAn enteric fistula that occurs in an open abdomen is called an enteroatmospheric fistula (EAF) and is the most challenging complication for a surgical team to deal with. The treatment of EAF requires a multidisciplinary approach. First of all, sepsis has to be managed. Any fluid, electrolyte and metabolic disorders need to be corrected. Oral intake must be stopped and total parenteral nutrition introduced. The control and drainage of the effluent from the fistula is a separate issue. Since there are no fixed algorithms for the treatment of EAF, surgeons need to develop their own, often highly unconventional solutions.We present the case of a 24-year-old man who developed enteroatmospheric fistula after laparotomy and relaparotomy due to acute necrotic pancreatitis. Both the laparostomy and the fistula were successfully managed using modified negative pressure wound therapy. The literature regarding this issue was also reviewed.

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Nurses Specialized in Wound, Ostomy and Continence Canada (NSWOCC) Management of Enterocutaneous Fistula and Enteroatmospheric Fistula

Journal of Wound Ostomy and Continence Nursing ◽

10.1097/won.0000000000000554 ◽

2019 ◽

Vol 46 (4) ◽

pp. 346-347

Author(s):

Jillian Brooke ◽

Amanda El-Ghaname ◽

Karen Napier ◽

Laureen Sommerey

Keyword(s):

Enterocutaneous Fistula ◽

Enteroatmospheric Fistula

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Use of the Amplatzer cardiac septal occluder to heal a recurrent high‐output chronic enteroatmospheric fistula

ANZ Journal of Surgery ◽

10.1111/ans.16191 ◽

2020 ◽

Author(s):

Giulio Del Zotto ◽

Gabriele Bellio ◽

Laura Bernardi ◽

Alan Biloslavo ◽

Nicolò de Manzini

Keyword(s):

Enteroatmospheric Fistula ◽

High Output

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Management of Enteroatmospheric Fistulae in the Open Abdomen

The American Surgeon ◽

10.1177/000313481007600630 ◽

2010 ◽

Vol 76 (6) ◽

pp. 637-639 ◽

Cited By ~ 14

Author(s):

Philip T. Ramsay ◽

Vicente A. Mejia

Keyword(s):

Open Abdomen ◽

Subcutaneous Tissue ◽

Case Series ◽

Early Mobilization ◽

Morbidity And Mortality ◽

Surgical Patients ◽

General Surgeon ◽

Enteroatmospheric Fistula ◽

The Face ◽

Tissue Flaps

There are few complications dreaded more by the general surgeon than the development of an enteroatmospheric fistula in the face of the open abdomen. The open abdomen has become a valuable tool in the treatment of trauma and complex surgical patients. The development of enteroatmospheric fistulae leads to increased cost, morbidity, and mortality. In our case series, we describe the use of Malecot catheters and early mobilization of skin and subcutaneous tissue flaps to manage enteroatmospheric fistulae. All of our patients were discharged from the hospital and did not develop any complications from the procedure. All of our patients’ fistulae ultimately closed. This procedure could lead to decreased cost and morbidity.

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Innovative approach to open abdomen: converting an enteroatmospheric fistula into an easily manageable stoma

BMJ Case Reports ◽

10.1136/bcr-2019-234207 ◽

2020 ◽

Vol 13 (8) ◽

pp. e234207

Author(s):

Michael Ron Freund ◽

Petachia Reissman ◽

Ram M Spira ◽

Moris Topaz

Keyword(s):

Wound Closure ◽

Open Abdomen ◽

Intestinal Fistula ◽

Morbidly Obese ◽

Vertical Gastroplasty ◽

Primary Wound Closure ◽

Morbidly Obese Patient ◽

Enteroatmospheric Fistula ◽

Relief System ◽

Emergent Laparotomy

A 52-year-old super morbidly obese patient underwent elective laparoscopic conversion of a failed silastic ring vertical gastroplasty to a Roux-en-Y gastric bypass. Following surgery, she developed an anastomotic leak which required emergent laparotomy. The patient then suffered from a complex postoperative course during which she developed an intestinal fistula which freely drained into the wound and gradually led to its complete dehiscence. Her course was further complicated by the surfacing of an enteroatmospheric fistula. This devastating complication was managed by employing the TopClosure Tension Relief system. Using the inverse maturation technique, further described in this report, we were able to progressively approximate and invert the edges of the skin around the enteroatmospheric fistula, thereby facilitating its conversion to an easily manageable stoma. Using this technique, we were able to achieve delayed primary wound closure of a grade 4 open abdomen complicated by an enteroatmospheric fistula in just under 5 weeks’ time.

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New isolation technique for enteroatmospheric fistula in Björck 4 open abdomen

Hernia ◽

10.1007/s10029-017-1614-y ◽

2017 ◽

Vol 21 (5) ◽

pp. 809-812 ◽

Cited By ~ 1

Author(s):

F. Yetisir ◽

A. E. Sarer ◽

M. Aldan

Keyword(s):

Open Abdomen ◽

Isolation Technique ◽

Enteroatmospheric Fistula

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Management of Enteroatmospheric Fistula and Floating Ileostomy: Would Eaken Wound Pouch Be the Answer? A Case Report

American Journal of Surgical Case Reports ◽

10.31487/j.ajscr.2020.03.05 ◽

2020 ◽

pp. 1-2

Author(s):

Abdirahaman Nuno ◽

A. Sinha ◽

Abdirahaman Nuno ◽

Mokhtar Eltair

Keyword(s):

Inflammatory Bowel Disease ◽

Case Report ◽

Rare Case ◽

Open Abdomen ◽

Granulomatous Inflammation ◽

Multidisciplinary Care ◽

Abdominal Tuberculosis ◽

Abdominal Sepsis ◽

Enteroatmospheric Fistula ◽

Inflammatory Bowel

Enterocutaneous and enteroatmospheric fistulas are the most challenging complications of abdominal sepsis to deal with a high mortality. This is even more challenging with a stoma in an open abdomen. In the setting of chronic granulomatous inflammation like abdominal tuberculosis or inflammatory bowel disease, recovery is prolonged and management involves multidisciplinary care. We present a rare case that was a complication of tuberculous peritonitis.

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