Management of a High-Output Postoperative Enterocutaneous Fistula with a Vacuum Sealing Method and Continuous Enteral Nutrition

Abstract

A postoperative enterocutaneous fistula is one of the most complex medical problems. Its treatment may become long-lasting, wearisome, and its outcome often is disappointing. Here, we describe the use of a novel device to treat a 67-year-old patient with a postoperative, high-output enterocutaneous fistula. A semipermeable barrier was created over the fistula by vacuum packing a synthetic, hydrophobic polymer covered with a self-adherent surgical sheet. To set up the system, we constructed a vacuum chamber equipped with precision instruments that supplied subatmospheric pressures between 350 and 450 mm Hg. The intestinal content was, thus, kept inside the lumen, restoring bowel transit and physiology. The fistula output was immediately reduced from a median of 800 ml/day (range, 400-1,600 ml/day), to a median of 10 ml/day (range, 0-250 ml/day), which was readily collected by the apparatus. Oral feeding was reinitiated while both parenteral nutrition and octreotide were withdrawn. No septic complications occurred, and the perifistular skin stayed protected from irritating intestinal effluents. Both the fistula orifice and the wound defect fully healed after 50 days of treatment. We believe this method may serve as a useful tool to treat selected cases of high-output enterocutaneous fistulas without the need for octreotide or parenteral nutrition.

Negative pressure wound therapy: An update

“…The fistulas that drain through a disrupted laparotomy always need an operative treatment and sometimes may be fatal 15, 16. Reports on the use of VAC in the treatment of enterocutaneous fistulas, as well as open abdomen, have been promising 17, 18, 19, 20. In this work, VAC was used to protect the surrounding skin from the leaking fistula before appropriate closure.…”

Nutrition and management of enterocutaneous fistula

“…This has the potential advantage of preserving small bowel secretions, although it is unacceptable to many patients. Another technique that has been used to facilitate enteral feeding is vacuum sealing of the fistula tract86–88. This has been described in a series of 74 patients with postoperative enterocutaneous fistula who were fed orally; a high rate of spontaneous fistula closure was reported87.…”

Experience With the Use of Vacuum Dressings in the Management of Acute Enterocutaneous Fistulas

“…Should the VAC dressing system continue to be used when it does not collapse the edges of the fistula together? An alternative vacuum sealing method has also been described by Hyon et al 18 They describe a high‐pressure vacuum over a synthetic hydrophobic polymer which effectively ‘seals’ the fistula and may be an alternative when the VAC system cannot collapse the edges of the fistula together.…”