“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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Discussion Other Sections Abstract I.

Management of an Entero-Atmospheric Fistula

Gastroenterol Res Pract ; Subsequently, wound crown method was applied to divert effluent of EAF, 2 but failed because perforation sites adjoined the abdominal wall.

On HD26, a perforation was observed 3 cm below the ileostomy. 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. Small bowel fistulas and the open abdomen. Eakin Wound Pouch in place. Discussion Figure Reference Enteroatmospheric fistula EAF is one of the most devastating complications in patients with an open abdomen and has associated morbidity and mortality rates.

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.

Most patients can tolerate some amount of enteral and even oral feeding and do not need to be maintained on PN alone. On HD2, right nephrectomy was performed due to complete infarction of the right kidney, but abdomen closure was unsuccessful due to severe bowel edema. Here the authors present the case of a year-old man who developed enteroatmospheric fistula after damage control laparotomy.

Management of the open abdomen: However, on HD44, the midline incisional wound necrotized and wound dehiscence re-occurred. 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. Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: This was in late October.


Enteroatmospheric fistula: from soup to nuts.

Eventually, when the fistula is closed, the suture is cut fistulz and the silicon plug is discharged at time of defecation. The photos were taken over a period of 3 months. Over the next three weeks, these measures were introduced and the patient was discharged on 31st July. Oral intake must be stopped until EAF was controlled and total parenteral nutrition introduced.

Biological dressings for the management of enteric fistulas in the open abdomen: Pelvic AP scan showing anteroposterior compression type 3 pelvic fracture A. The AAST American Association for the Surgery of Trauma Open Abdomen Study Group reported that enteroatmspheric resection, large-volume resuscitation, and a greater number of re-explorations were significant predictors of development of a fistula within an open abdomen after trauma. This way leakage was avoided.

The new care management plan involved use of a wound pouching system, fitsula facilitated the maintenance of moisture around the wound while allowing fistula output to drain. Search for Search All Journals.

Enteroatmospheric Fistula Associated with Open Abdomen

At the same time, wound healing was prompted, fistula output could be effectively monitored and the patient was able to be mobile. A born gentleman presented at the hospital with intestinal obstruction and a parastomal hernia.

Collapsible enteroatmospheric fistula isolation device: Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access enteroatmosphegic excision of the involved loop are reviewed in this report.

ETF healing is normally expedited by a combination of effective wound management and nutritional input. A small hole is shaped into the VAC sponge to hold the nipple in place.

A simple novel technique for enteroatmospheric fistulae: Wound size had markedly reduced to a bare minimum 2cm in diameter down from 10cm. All of these methods enteroatmoshperic result in good outcomes but all require appropriate experience. Multiple perforations of small intestine and liver laceration were observed in operation.


What is the effectiveness of the negative pressure wound therapy NPWT in patients treated with open abdomen technique? 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. The progress during the month of September was impressive eenteroatmospheric wound closure was imminent.

After 1 day in hospital hospital day 1; HD1Continuous renal replacement therapy was implemented due to acute kidney injury. Recently, negative pressure wound therapy was introduced to manage OA. A baby bottle nipple method was tried and quite successful somedays but fixation of the nipple on the EAF was not easy.

Management of an Entero-Atmospheric Fistula

Fistla on initial presentation. I first saw the patient in July, and I stopped my management in October. Eastern Association for enteroatmoospheric Surgery of Trauma: Considerable difficulty was experienced managing EAF in the described patient, primarily due to a lack of experience. On HD24, symptoms of peritonitis appeared and exploratory laparotomy was undertaken.

After seeing how ebteroatmospheric progress had been made, the plastic surgeon was of the opinion that the existing care plan should continue until maximum closure occurred. Coronal view abdominal CT scan showing complete infarction of the right kidney B and mesenteric bleeding C.

Component separation technique using an anterior rectus sheath turnover A. Sign up for Eakin updates. Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging.

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. The patient later developed an entero-cutaneous fistula, which was managed in due course.