Management of Enteroatmospheric Fistulae Developing Post Sitoreductive Surgery

Abstract

If an open abdominal patient develops enteric fistulae, the condition will be defined as enteroatmospheric fistulae (EAF). As it is not covered with tissue and does not have a fistula tract, it cannot be considered a real fistula. In total, 25% of open abdominal patients develop EAF and have a mortality rate of approximately 42%-75%. In this article, we present the case of a patient with EAF developing post sitoreductive surgery. As the recovery time of grade 4 open abdominal patients can be 6 months or longer, it was our aim to convert the fistula mouth to a stoma. (JAREM 2016; 6: 122-5)

Apendektomiye Bağlı Bridektomi Sonrası Gelişen Enteroatmosferik Fistülün Yönetimi

“…Another method for EAF isolation is nursing bottle teat technique identified by Layton et al, in 2010(Layton et al, 2010. Layton et al, enabled drainage by placing a soft standard latex or silicone baby bottle teat on fistula and connecting foley catheter to the teat (Layton et al, 2010;Ulukent et al, 2016). In our case, the technique named nursing bottle teat in combination with the VAC method was individualized due to the fact that the fistula was highly dynamic and the foley catheter was ejected.…”

“…Therefore, their need for nutrition and energy must be met by providing protein and vitamin support (Marinis et al, 2013). In our case, the patient was provided with parenteral nutrition support and hypoalbuminemia was countered with albumin replacement and his liquid balance was assured (Eğin et al, 2019;Ulukent et al, 2016). Antibiotic therapy was applied against wound infection and sepsis (Marinis et al, 2013;Terzi et al, 2014).…”

“…When EAF develops, it gets more difficult to treat patients with open abdomen and the probability of morbidity and mortality increase (Eğin et al, 2019;Tarasconi et al, 2019). In case of a development of EAF, it must be diagnosed as soon as possible, and a definitive surgical treatment must be conducted after tissue recovery (Ulukent et al, 2016). In the management of EAF, a multidisciplinary team approach is critical and stoma and wound care nurses are essential elements of the team (Tarasconi et al, 2019).…”

“…Enteroatmospheric Fistula (EAF) is a condition that creates an opening from the gastrointestinal system which develops without a soft tissue on (Tarım and Kuş, 2018). EAF, which develops after a trauma or an abdominal surgery, is mostly associated with electrolyte abnormality, malnutrition and sepsis which is fatal (Ulukent et al, 2016). EAF is known to develop in 25% of patients (Ulukent et al, 2016) and have a mortality rate ranging between 42-75% (Leang et al, 2018;Marinis et al, 2014;Taraconi et al, 2019;Ulukent et al, 2016).…”

“…Open abdomen classification of The World Society of the Abdominal Compartment and Björck's revision of the classification system is present Table 1 (Björck et al, 2016). EAF is not a true fistula as it is not covered with a tissue or having a fistula tract and it is quite difficult to close spontaneously (Ulukent et al, 2016). While low output distal fistula without distal obstruction, and that does not contain an extraneous particle can close spontaneously, proximal, high output fistulas have a low probability of closure without surgery (Ramsay and Mejia 2010;Ulukent et al, 2016;Wright and Wright, 2011).…”