“Enteroatmospheric” Fistula: The Feared Complication of the. “Open Abdomen”. William Schecter, MD, FACS. Professor of Clinical Surgery. University of. An enteroatmospheric fistula (EAF) is a known, morbid complication of open abdomen (OA) treatment. Patients with EAF often require repeated operations and. A small-bowel enteroatmospheric fistula (EAF) is an especially challenging complica- taneous fistulae, EAFs have neither overlying soft tissue nor a real fistula.
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Lateral incisions were made to close skin at the midline incision B. Lastly, we applied a large colostomy bag or frequent gauze dressing. All techniques described aim to completely divert fistula output to protect surrounding viscera and allow clean granulation of exposed bowel, thus causing the fistula to become chronic and controlled.
Due to enteroatmospyeric and the losses caused by laparostomy and the fistula, appropriate calorie, protein, vitamin and enferoatmospheric supplies must be ensured. A baby bottle rubber nipple is placed over the fistula opening and a Pezzer tube, Malecot, or Foley catheter is placed through a small hole cut into the tip of the nipple Fig.
On HD2, right nephrectomy was performed due to complete infarction of the right kidney, but abdomen closure was unsuccessful due to enteroatmospherix bowel edema. Following this advice, I continued with the existing care plan. In early December, I was informed that the wound was closed surgically but that this was made possible due to the considerable work carried out previously to shrink the wound.
On HD24, symptoms of peritonitis appeared and exploratory laparotomy was undertaken. Cyanoacrylates can be beneficial for small EAFs, especially as entsroatmospheric adjunct to primary suturing.
It should be noted that EAF almost never close spontaneously, and definitive repair usually requires major surgical intervention and abdominal wall reconstruction 6 to 12 months after the original insult. Blood transfusion and warming were immediately instituted.
Management of an Entero-Atmospheric Fistula
Enteral feeding should be attempted once the anatomy of the EAF is defined and reliable enteral access is obtained. In this regard, an effective nutritional plan was implemented and fluid intake was increased to about 2.
Negative-pressure wound therapy for critically ill adults with open abdominal wounds: ETF on initial presentation. The patient later developed an entero-cutaneous fistula, which was managed in due course. I first saw the patient in July, and I stopped my management in October. Eventually, when the fistula is closed, the suture is cut off and the silicon plug is discharged at time of defecation.
Enteroatmospheric fistula: from soup to nuts.
A layer of colostomy paste can be placed under the nipple to ensure a better seal. His mental status was alert but he was hypothermic.
This way leakage was avoided. Abstract Other Sections Abstract I. However, on HD44, the midline incisional wound necrotized and wound dehiscence re-occurred. Attempt to rationalize the approach to a surgical nightmare and proposal of a clinical algorithm. References Other Sections Abstract I. Open Abdomen Advisory Panel.
Enteroatmospheric fistula: from soup to nuts.
At the time of my intervention, the entero-atmospheric fistula ETF was being managed by negative wound pressure therapy NWPT with little entedoatmospheric. He remained in a bedridden state awaiting pelvic surgery.
The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with. A systematic review and meta-analysis. Open abdomen with concomitant enteroatmospheric fistula: Initially, sepsis has to be managed and any fluid, electrolyte, and metabolic disorders need to be corrected.
Perforation of right colon at the hepatic flexure was observed and right hemicolectomy with ileostomy was performed. On HD26, a perforation was observed 3 cm below the ileostomy. Eastern Association for the Surgery of Trauma: World J Emerg Surg ;8: In retrospect, the Vaseline gauze barrier between the reticular foam of vacuum assisted closure VAC and open viscera was inadequate, and the sometimes high negative pressure mmHg applied to drain effluent resulted in injury and bleeding of serosa.
Previously made Ileostomy site white arrownewly made stoma black arrowpin site of the external fixator black arrow headand the incision made for preperitoneal pelvic packing white arrowhead. An interventional laparotomy was subsequently carried out.
To expedite healing, henceforth daily system changes were recommended. This was how the wound was managed to ensure wound closure and thereafter the fistula should close spontaneously. Enteroatmospheric fistula, Open abdomen, Negative pressure wound therapy. External fixation of the pelvis was immediately followed by abdominal surgery.
Enteroatmospheric Fistula Associated with Open Abdomen
At this point, a muscle flap would be created over the fistula alone, as the wound would have already closed. This was in late October. Most patients can tolerate some amount enteroatmoepheric enteral and even oral feeding and do not need to be maintained on PN alone. Additionally, we describe enteroatospheric recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.
This flexible device is designed to create a channel for effluent while maintaining the integrity and beneficial aspects of the NPWT dressing.
Enteroatmospheric fistula EAFa special subset of enterocutaneous fistula ECFis defined as a communication enteroatospheric the gastrointestinal GI tract and the atmosphere. When treating patients with risk factors, efforts should be made to prevent EAF development and devise better techniques for diverting effluent.