The Use Of Negative Pressure Wound Therapy (NPWT) In The Management Of Enteroatmospheric Fistula – Case Report And Literature Review

Abstract

c A S E R E P O R t SAn enteric fistula that occurs in an open abdomen is called an enteroatmospheric fistula (EAF) and is the most challenging complication for a surgical team to deal with. The treatment of EAF requires a multidisciplinary approach. First of all, sepsis has to be managed. Any fluid, electrolyte and metabolic disorders need to be corrected. Oral intake must be stopped and total parenteral nutrition introduced. The control and drainage of the effluent from the fistula is a separate issue. Since there are no fixed algorithms for the treatment of EAF, surgeons need to develop their own, often highly unconventional solutions. We present the case of a 24-year-old man who developed enteroatmospheric fistula after laparotomy and relaparotomy due to acute necrotic pancreatitis. Both the laparostomy and the fistula were successfully managed using modified negative pressure wound therapy. The literature regarding this issue was also reviewed.

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

“…In about half of the cases, different techniques for fistula isolation were used, whereas in the other half of patients, NPWT with/without special fistula patches/plugs were employed for fistula occlusion . Three possible outcomes are described for EAF treatment: spontaneous closure, conditioning of the surrounding wound, and conversion into an ECF with delayed surgical fistula elimination or definite ECF without need for fistula elimination . Furthermore, in 38.5% of the cases, there was spontaneous fistula closure during treatment, with higher probability in low‐output fistulas .…”

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

“…Whether the use of VSD after abdominal surgery can lead to secondary intestinal injury and increase the incidence of intestinal fistulas is controversial. At present, an increasing number of studies have confirmed that the use of VSD does not increase the incidence of intestinal fistulas 21, 30, 34, 50, 55, 96, 127, 145, 148, 152, 154, 156…”

“…A total of 22 studies were included, one RCT, 110 one systematic review, 111 and 20 observational studies. 80 , 93 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 …”

“…At present, an increasing number of studies have confirmed that the use of VSD does not increase the incidence of intestinal fistulas. 21 , 30 , 34 , 50 , 55 , 96 , 127 , 145 , 148 , 152 , 154 , 156 …”

“…Treatment of an open abdomen with an enteroatmospheric fistula is very tricky. VSD has been reported to have many advantages for the treatment of enteroatmospheric fistulas 93, 127. Regarding the study of isolation techniques for enteroatmospheric fistulas, four observational studies showed that VAC could be combined with a “ring”/“silo”, tire ring, or pacifier method to isolate wounds and intestinal fistulas 80, 123, 124, 125…”