The use of negative‐pressure wound therapy to manage enteroatmospheric fistulae in two patients with large abdominal wounds

Abstract

Enteric fistulae are a relatively common complication of bowel surgery or in surgery where the bowel has been exposed. Fistulae can present a significant threat to patients' well-being. Changes in surgical techniques and in particular the rise in damage control surgery for emergency patients have led to an increase in open abdominal wounds. The presence of an enteroatmospheric fistula on the surface of a wound can cause a number of distressing symptoms/issues for the patient whilst providing a significant challenge for the clinician. The loss of fluid, proteins and electrolytes will place the patient in danger of becoming hypokalaemic and malnourished. A variety of techniques are available, most refer to a method of isolating the fistula using stoma rings or washers and ostomy paste. The role of negative pressure in the management of wounds with fistula is in its infancy; however, there is evidence to suggest that isolation techniques can be advantageous in managing wounds with fistulae.

Management of enteroatmospheric fistula with negative pressure wound therapy in open abdomen treatment: a multicentre observational study

“…With the constant advances in the field of NPWT, many modifications of NPWT have been reported, especially designed for open abdomen management complicated with EAF. Fistula VAC, Tube VAC, Nipple VAC and Chimney VAC have been described as important alternatives for EAF in the open abdomen management (36)(37)(38)(39)(40). Every case of open abdomen management is different, and thus, a particular method may be dedicated to one patient, whereas for another case, the optimal management may be based on another method.…”

Successful treatment of enteroatmospheric fistulas in combination with negative pressure wound therapy: Experience on 3 cases and literature review

“…Enterocuteaneous (ECF) and enteroatmospheric fistulas (EAF) are rare but challenging complications of abdominal surgery. Furthermore, they are associated with high morbidity and mortality and remarkably impair patients' quality of life . EAF is defined as a pathological communication between the intestinal lumen and the surface of an open abdominal wound .…”

“…Furthermore, they are associated with high morbidity and mortality and remarkably impair patients' quality of life . EAF is defined as a pathological communication between the intestinal lumen and the surface of an open abdominal wound . They can be classified by the amount of daily faecal output (high/low), location in relation to the abdominal cavity (superficial/deep), the involved intestinal segment (proximal/distal), and the number of fistula openings (single/multiple) .…”

“…They can be classified by the amount of daily faecal output (high/low), location in relation to the abdominal cavity (superficial/deep), the involved intestinal segment (proximal/distal), and the number of fistula openings (single/multiple) . Inadequate treatment of laparostomy can also cause EAF . While mortality rates associated with EAF decreased over the last years due to progress in perioperative management, some authors still report mortality rates of up to 40% .…”

“…While mortality rates associated with EAF decreased over the last years due to progress in perioperative management, some authors still report mortality rates of up to 40% . Some authors report an EAF incidence of up to 10% in patients undergoing open abdomen treatment for peritonitis and abdominal compartment syndrome and of up to 55% for patients suffering from abdominal sepsis . Analysis of 82 consecutive cases documented in the EuraHS Open Abdomen Route registry demonstrated an incidence of small bowel fistulas of 5.5% in patients with laparostomy .…”