“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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Enteral feeding should be attempted once the anatomy enteroatmosphsric the EAF is defined and reliable enteral access is obtained. His mental status was alert but he was hypothermic. Management of the open abdomen: Due to hypercatabolism and the enteeroatmospheric caused by laparostomy and the fistula, appropriate calorie, protein, vitamin and microelement supplies must be ensured.
For many years, the application of negative pressure wound therapy NPWT was considered to increase the possibility of fistula formation, but additional studies have demonstrated that NPWT is safe.
Multiple perforations of small intestine and liver laceration were observed in operation. Open Abdomen Advisory Panel.
Enteroatmospheric fistula: from soup to nuts.
After 1 day in hospital hospital day 1; HD1Continuous renal replacement therapy was implemented due to acute kidney injury. The new care management plan involved use enteroatmospheirc a wound pouching system, which facilitated the maintenance of moisture around the wound while allowing fistula output to drain.
This is a plug designed to seal the EAF from inside, and consists of a circular disk of 1-mm thick silicone of diameter of 2 to 5 cm Fig. Discussion Figure Reference A year-old male patient was admitted to trauma surgery department after a motorcycle accident. Blood transfusion and warming were immediately instituted. A systematic review and meta-analysis. Then, a fistula plug was applied, but it was difficult to fix the plug in the EAF.
Kang Kook Choi, M.
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. This flexible device is designed to create a channel for effluent while maintaining the integrity and beneficial aspects of the NPWT dressing. Discussion Other Sections Abstract I. A small hole is shaped into the VAC sponge to hold the nipple in place.
Request for Case Studies If you have experience in using the Eakin products we would love you to share it with us. References Other Sections Abstract I. Considerable difficulty was experienced managing EAF in the described patient, primarily due to a lack of experience. As a result, the spontaneous healing of EAF is nearly impossible. Coronal view abdominal CT scan showing complete infarction of the right kidney B and mesenteric bleeding C.
As from 15th August, the management of the entero-atmospheric fistula involved ensuring that the wound size continued to decrease. What is the effectiveness of the negative pressure wound therapy NPWT in patients treated with open abdomen technique? However, he had an open abdomen and an entero-atmospheric fistula developed thereafter. Discussion Figure Reference Considerable difficulty was experienced managing EAF in the described patient, primarily due to a lack of experience.
External fixation of the pelvis was immediately followed by abdominal surgery.
Management of enteroatmospheric fistulae.
Professional judgment, experience, and teamwork are key to successfully managing the patient with EAF. Enteroatmowpheric abdominal closure was performed after perihepatic gauze packing, resection of 50 cm of small intestine, and preperitoneal pelvic packing. When treating patients with risk factors, efforts should be made to prevent EAF development and devise better techniques for diverting effluent.
Introduction Other Sections Abstract I.
Enteroatmospheric fistula: from soup to nuts.
Subsequently, wound crown method was applied to divert effluent of EAF, 2 but failed because perforation sites adjoined the abdominal wall. It should be noted that EAF almost never close spontaneously, and definitive repair usually requires major surgical intervention and abdominal enteroatmosphegic reconstruction 6 to 12 months after the original insult.
Enteroatmospheric fistula EAFa special subset of enterocutaneous fistula ECFis defined as a communication between the gastrointestinal GI tract and the atmosphere. The bridge is fixed to the abdominal wall using a self-adhesive plaster.
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A simple novel technique enteroatmospherjc enteroatmospheric fistulae: The number of patients with EAF is expected to increase when the trauma centers are activated.
Here the authors present the case of a year-old man who developed enteroatmospheric fistula after damage control laparotomy. The silicone plug is then rolled and inserted into the fistula, the plug is hung on the bridge using a suspension suture and the rubber band.
ETF on initial presentation. On HD2, right nephrectomy was performed due to complete infarction of the right kidney, but abdomen closure was unsuccessful due to severe bowel edema. With this new approach, it was intended that granulation would occur, as faecal content does hinder the process. On HD4, the abdomen was closed using the component separation technique Fig.
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.
After seeing how much progress had been made, the plastic surgeon was of the opinion that the existing care plan should continue until maximum closure occurred. At this point, a muscle flap would be created over the fistula alone, as the wound would have already closed.
A layer of colostomy paste can be placed under the nipple to ensure a better seal. Recently, negative pressure wound therapy was introduced to manage OA. World J Emerg Surg ;8: Biological dressings for the management of enteric fistulas in the open abdomen: Enteroatmospheric fistula EAF is one of the most devastating complications in patients with an open abdomen and has associated morbidity and mortality rates.
Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: At some point, a floating stoma was created, and with the impressive healing progress, this became unnecessary.
Wound size had markedly reduced to a bare minimum 2cm in diameter down from 10cm.