“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.
|Published (Last):||23 March 2014|
|PDF File Size:||17.26 Mb|
|ePub File Size:||10.65 Mb|
|Price:||Free* [*Free Regsitration Required]|
However, the doctors soon decided on a muscle flap rotation and the family opted to go to South Africa. The number of patients with EAF is expected to increase when the trauma centers are activated. 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 snteroatmospheric significant predictors of development of a fistula within an open abdomen after trauma.
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.
However, he had an open abdomen and an entero-atmospheric fistula developed thereafter. Coronal view abdominal Enteroatmosphfric scan showing complete infarction of the right kidney B and mesenteric bleeding C.
Many of the principles applied to classic enterocutaneous fistulae are used as well. A baby bottle nipple method was tried and quite successful entrroatmospheric but fixation of the nipple on the EAF was not easy.
Professional judgment, experience, and teamwork are key to successfully managing the patient with EAF. Collapsible enteroatmospheric fistula isolation device: New Care Management Plan: The new care management plan involved use of a wound pouching system, which facilitated the maintenance of moisture around the wound while allowing fistula output to drain.
To expedite healing, henceforth daily system changes were recommended. Sand Schecter WP. Following this advice, I continued with the enterroatmospheric care plan. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs.
Comparison of outcomes between early fascial closure and delayed abdominal closure in patients with fitsula abdomen: This was how the wound was managed to ensure wound closure and thereafter the fistula should close spontaneously. Enteroatmospheirc, when the fistula is closed, the suture is cut off and the silicon plug is discharged at time of defecation.
Blood transfusion and warming were immediately instituted. Sign up for Eakin enteroatmsopheric.
Enteroatmospheric fistula: from soup to nuts.
What is the effectiveness of the negative pressure wound therapy NPWT in patients treated with open abdomen technique? Abstract Other Sections Abstract I. All of these methods may result in good outcomes but all require appropriate experience. A simple novel technique for enteroatmospheric fistulae: Lastly, we applied a large colostomy entroatmospheric or frequent gauze dressing. J Am Coll Surg ; Search for Search All Journals. Most patients can tolerate some amount of enteral and even oral enteroatmospjeric and do not need to be maintained on PN alone.
Management of enteroatmospheric fistulae.
On HD4, the enteroatmos;heric was closed using the component separation technique Fig. After seeing how enteroatmospheeric progress had been made, the plastic surgeon was of the opinion that the existing care plan should continue until maximum closure occurred. There were two options available to us; either to allow the small wound left pictorial available to close spontaneously or for the plastic surgeon to do a muscle flap.
Quality of life after abdominal wall reconstruction following open abdomen. Then, a fistula plug was applied, but it was difficult to fix the plug in the EAF. Introduction Other Sections Abstract I. Due to hypercatabolism and the enteroatmospheruc caused by laparostomy and the fistula, appropriate calorie, protein, vitamin and microelement supplies must be ensured.
The photos were taken over a period of 3 months. At this point, a muscle flap would be created over the fistula alone, as the wound would have already closed.
Open abdomen with concomitant enteroatmospheric fistula: Segmental resection of the perforated bowel was performed successfully. Control of enteric spillage, attempts to seal the fistula, and techniques of peritoneal access for excision of the involved loop are reviewed in this report.
An interventional laparotomy was subsequently carried out. Pelvic Fistua scan showing anteroposterior compression type 3 pelvic fracture A.
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. Request for Case Studies If you have experience in using the Eakin products we would love you to share it with us.
Considerable difficulty was experienced managing Tistula in the described patient, primarily due to a lack of experience. Biological dressings for the management of enteric fistulas in the open abdomen: At the time of my intervention, the entero-atmospheric fistula ETF was being managed by negative wound pressure therapy NWPT with little success.
At the same time, wound healing was prompted, fistula output could be effectively monitored and the patient was able to be mobile. However, on HD44, the midline incisional wound necrotized and wound dehiscence re-occurred.