“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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Negative-pressure wound therapy for critically ill adults with open abdominal wounds: This was how the wound was managed to ensure wound closure and thereafter the fistula should close spontaneously. A small hole is shaped into the VAC sponge to hold the nipple in place.
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. 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 fnteroatmospheric.
Petroleum impregnated gauze or clear Telfa sheet is then placed over the bowel and enteroatmospehric entire wound is covered using a commercial VAC dressing.
At the time of my enteroatmosphsric, the entero-atmospheric fistula ETF was being managed by negative wound pressure therapy NWPT with little success.
The progress during the month of September was impressive and wound closure was imminent. Sign up for Eakin updates. Component separation technique using an anterior rectus sheath turnover A.
Open Abdomen Advisory Panel. Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome.
Pacifying the open abdomen with concomitant intestinal fistula: This was in late October. 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.
Biological dressings for the management of enteric entegoatmospheric in the open abdomen: 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. Attempt to rationalize the approach to a surgical nightmare and proposal of a clinical algorithm.
Enteroatmospheric Fistula Associated with Open Abdomen
A layer of colostomy paste can be placed under the nipple to ensure a better seal. Eventually, when the fistula is closed, the suture is cut off and the silicon plug is discharged at time of defecation. 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.
Other Sections Abstract I. 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. Most patients can tolerate some amount of enteral and even oral feeding and do not need to be maintained on PN alone.
Management of enteroatmospheric fistulae.
At some point, a floating stoma was created, and with the impressive healing progress, this became unnecessary. In this regard, an effective nutritional plan was implemented and fluid intake was increased to about 2. Discussion Figure Reference A year-old male patient was admitted to trauma surgery department after a motorcycle accident. Comparison of outcomes between early fascial closure and delayed abdominal closure in patients with open abdomen: Management of the open abdomen: World J Emerg Surg ;8: Prevention is clearly the best treatment strategy but may be difficult to achieve.
As a result, the spontaneous healing of EAF is nearly impossible.
Discussion Figure Reference Considerable difficulty was experienced managing EAF in the described patient, primarily due to a lack of experience. On HD26, a perforation was observed 3 cm below the ileostomy.
Management of enteroatmospheric fistulae.
Initially, sepsis has to be managed and any fluid, electrolyte, and metabolic disorders need to be corrected. 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. It is one of the most devastating complications of “damage control” laparotomy DCL and results in significant morbidity and mortality.