“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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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. Temporary abdominal closure was performed after perihepatic gauze packing, resection of 50 cm of small intestine, and preperitoneal pelvic packing. With this new approach, it was intended that granulation would occur, as enteroatmospheeic content does hinder the process.
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.
Many of the principles applied to classic enterocutaneous fistulae are used as well. Recently, negative pressure wound therapy was introduced to manage OA.
This was in late October. However, on HD44, the midline incisional wound necrotized and wound dehiscence re-occurred. Perforation of right colon at the hepatic flexure was observed and right hemicolectomy with ileostomy was performed. Over the next three weeks, these measures were introduced and the patient was discharged on 31st July.
No gold standard therapy has been established for the treatment of EAF, and thus, treatment decision making is dependent on the experience of medical staff.
Enteroatmospheric fistula: from soup to nuts.
fietula Introduction Other Sections Abstract I. Professional judgment, experience, and teamwork are key to successfully managing the patient with EAF. This was how the wound was managed to ensure wound closure and thereafter the fistula should close spontaneously.
Most patients can tolerate some amount of enteral and even oral feeding and do not need to be maintained on PN alone.
Biological dressings for the management of enteric fistulas in the open abdomen: Computed tomography revealed liver laceration, bleeding of mesentery, complete infarction of the right kidney, multiple rib fractures, and a pelvic bone fracture Anterior Posterior Compression type III Fig. After 1 day in hospital hospital day 1; HD1Continuous renal replacement therapy was implemented due to acute kidney injury. Management of the open abdomen: Int Wound J ; The AAST American Association for the Surgery of Trauma Open Abdomen Study Group reported that large-bowel resection, large-volume resuscitation, and a greater number of re-explorations were significant predictors of development of a fistula within an open abdomen after trauma.
New Care Management Plan: Discussion Figure Reference Figures Fig. Enteroatmospheric fistula EAFa special subset of enterocutaneous fistula ECFis defined as a communication between the gastrointestinal GI tract and the atmosphere. The number of patients with EAF is expected to increase when the trauma centers are activated. Here the authors present the case of a year-old man who developed enteroatmospheric fistula after damage control laparotomy.
Enteroatmospheric fistula: from soup to nuts.
EAF presents a huge challenge and requires a multidisciplinary – surgical, metabolic, nutritional, and nursing – approach. Gastroenterol Res Pract ; Negative-pressure wound therapy for critically ill adults with open abdominal wounds: Abstract Other Sections Abstract I. Fistul layer of colostomy paste can be placed under the nipple to ensure a better seal.
The pouching system was changed on alternate days. At the time of my intervention, the entero-atmospheric fistula ETF was being managed by negative wound pressure therapy NWPT with little success. A systematic review and meta-analysis.
Kang Kook Choi, M. J Trauma Acute Care Surg ; A baby bottle nipple method was tried and quite successful somedays but fixation of the nipple on the EAF was not easy.
Nevertheless, treatment involves the following; 1 sepsis must be managed, 2 sufficient nutritional support must be provided, and 3 effluent must be isolated from skin and open viscera.
In early December, I was informed that the wound was closed surgically but that this was made possible due to the considerable work carried out previously to shrink the wound. The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with.
Oral intake must be stopped until EAF was controlled and total parenteral nutrition introduced. The patient later developed an entero-cutaneous fistula, which was managed in due course. Small bowel fistulas and the open abdomen.
Management of an Entero-Atmospheric Fistula
Scand J Surg ; Discussion Figure Reference A year-old male patient was admitted to trauma surgery department after a motorcycle accident. External fixation of the pelvis was immediately followed by abdominal entegoatmospheric. This way leakage was avoided. Coronal view abdominal CT scan showing complete infarction of the right kidney B and mesenteric bleeding C.
It is one of the most devastating complications of “damage control” laparotomy DCL enteroatmosphedic results in significant morbidity and mortality.