“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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The pouching system was changed on alternate days. Professional judgment, experience, and teamwork are fistulx to successfully managing the patient with EAF. Their etiology is complex and ranges from persistent abdominal infection, anastomotic leakage, adhesions of the bowel to itself or fascia, and repeated bowel manipulation during return trips to the operating room or dressing changes.
Cyanoacrylates can be etneroatmospheric for small EAFs, especially as an adjunct to primary suturing. Petroleum impregnated gauze or clear Telfa sheet is then placed over the bowel and the entire wound is covered using a commercial VAC dressing. Kang Kook Choi, M. A baby bottle nipple method was tried and quite successful somedays but fixation of the nipple on the EAF was not easy.
Enteroatmospheric Fistula Associated with Open Abdomen
This flexible device is designed to create a channel for effluent while maintaining the integrity and beneficial aspects of the NPWT dressing. Other Sections Abstract I. Pacifying the open abdomen with concomitant intestinal fistula: A Vicryl suture is passed through the center of the silicon circle and then tied to a rubber band attached to bridge of foam-covered aluminum.
Open Abdomen Advisory Panel. Negative-pressure wound therapy for critically ill adults with open abdominal wounds: As from 15th August, the management of the entero-atmospheric fistula involved ensuring that the wound size continued to decrease.
The patient later developed an entero-cutaneous fistula, which was managed in due course. Perforation of right colon at the hepatic flexure was observed and right hemicolectomy with ileostomy was performed. At some point, a floating stoma was created, and with the impressive healing progress, this became unnecessary.
Temporary abdominal closure was performed after perihepatic gauze packing, resection of 50 cm of small intestine, and preperitoneal pelvic packing. There were two options available to us; either to allow the small wound left pictorial available to close spontaneously or for the plastic surgeon to do a muscle flap. ETF on initial presentation.
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. Discussion Other Sections Abstract I.
Management of an Entero-Atmospheric Fistula
Attempt to rationalize the approach to a surgical nightmare and proposal of a clinical algorithm. December31 3.
Sign up for Eakin updates. No gold standard therapy has been established for the treatment of EAF, and thus, treatment decision making is dependent on the experience of medical staff.
Enteroatmospheric fistula: from soup to nuts.
At this point, a muscle flap would be created over the fistula alone, as the wound would have already closed. However, on HD44, the midline incisional wound necrotized and wound dehiscence re-occurred.
Subsequently, wound crown method was applied to divert effluent of EAF, 2 but failed because perforation sites adjoined the abdominal wall. When treating patients with risk factors, efforts should be made to prevent EAF development and devise better techniques for diverting effluent.
Blood transfusion and warming were immediately instituted. A small hole is shaped into the VAC sponge to hold the nipple in place. This way leakage was avoided. On HD24, symptoms of peritonitis appeared and exploratory laparotomy was undertaken. To expedite healing, henceforth daily system changes were recommended. Computed tomography revealed liver laceration, bleeding of mesentery, complete infarction of the right kidney, multiple rib fractures, and a pelvic bone fracture Anterior Posterior Compression type III Fig.
J Trauma Acute Care Surg ; As a result, the spontaneous healing of EAF is nearly impossible.