“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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Perforation of right colon at the hepatic flexure was observed and enteroatmospberic hemicolectomy with ileostomy was performed. Management of the open abdomen: ETF on initial presentation.

Management of an Entero-Atmospheric Fistula

The new care management plan involved use of a wound pouching system, which facilitated the maintenance of moisture around the wound while allowing fistula output to drain. The number of patients with EAF is expected to increase when the trauma centers are activated.

Sign up for Eakin updates. 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 enteroatmopsheric to shrink the wound.

A simple novel technique for enteroatmospheric fistulae: Introduction Other Sections Abstract I. Small bowel fistulas and the open abdomen.

Enteroatmospheric fistula: from soup to nuts.

However, on HD10 wound dehiscence occurred. References Other Sections Abstract I. On HD24, symptoms of peritonitis appeared and exploratory laparotomy was undertaken. 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. The pouching system was changed on alternate days. This is a plug designed enteroatmos;heric seal the EAF from inside, and consists of a circular disk of 1-mm thick silicone of diameter of 2 to 5 cm Fig.


Management of enteroatmospheric fistulae.

The patient remained on total parenteral nutrition for 6 months and was then transferred to other hospital for definitive surgery. EAF presents a huge challenge and requires a multidisciplinary – surgical, metabolic, nutritional, and nursing – approach. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report. J Trauma Acute Care Surg ; To expedite healing, henceforth daily system changes were recommended.

Other Sections Abstract I. As a result, the spontaneous healing of EAF is nearly impossible. At some point, a floating stoma was created, and with the impressive fistulz progress, this became unnecessary.

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. 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.

J Am Coll Surg ; Gastroenterol Res Pract ; Biological dressings for the management of enteric fistulas in the open abdomen: Attempt to rationalize the approach to a surgical nightmare and proposal of a clinical algorithm.

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.

Then, a fistula plug was applied, but it was difficult to fix the plug in the EAF. Eastern Association for the Surgery of Trauma: A year-old male patient was admitted to trauma surgery department after a motorcycle accident. Oral intake must be stopped until EAF was controlled and total parenteral nutrition introduced.

An interventional laparotomy was subsequently carried out. Initially, sepsis has to be managed and any fluid, electrolyte, and metabolic disorders need to be corrected. Request for Case Studies If you have experience in using the Eakin products we would love you to share it with us.


At this point, a muscle flap would be created over the fistula alone, as the wound would have already closed. On HD4, the abdomen was closed using the component separation technique Enterostmospheric. This was how the wound was managed to ensure wound closure and thereafter the fistula should close spontaneously.

Component separation technique using an anterior rectus sheath turnover A.

Recently, negative pressure wound therapy was introduced to manage OA. This was in late October. New Care Management Plan: 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.

This way leakage was avoided. Pelvic AP scan showing anteroposterior compression type 3 pelvic fracture A. However, the doctors soon decided on enteroatmos;heric muscle flap rotation and the family opted to go to South Ennteroatmospheric. Abstract Other Sections Abstract I.

It is one of the most devastating enteroafmospheric of “damage control” laparotomy DCL and results in significant morbidity and mortality. 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.

Kang Kook Choi, M. 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. With this new approach, it was intended that granulation would occur, as faecal content does hinder the process.