“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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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.

There were two options available to us; either to allow the small wound left enetroatmospheric available to close spontaneously or for the plastic surgeon to do a muscle flap. J Trauma Acute Care Surg ; The silicone plug is then rolled and inserted into the fistula, the plug is hung on the bridge using a suspension suture and the rubber band. Enteroatmospheric fistula, Open abdomen, Negative pressure wound therapy. With this new approach, it was intended that granulation would occur, as faecal content does hinder the process.

An interventional laparotomy was subsequently carried out.

Management of an Entero-Atmospheric Fistula

Segmental resection of the perforated bowel was performed successfully. At the same time, wound healing was prompted, fistula output could be effectively monitored and the patient was enteroatmopheric to be mobile.

Attempt to rationalize the approach to a surgical nightmare and proposal of a clinical algorithm. Pelvic AP scan showing anteroposterior compression type 3 pelvic fracture A.


Small bowel fistulas and the open abdomen. Then, a enteroatmospueric plug was applied, but it was difficult to fix the plug in the EAF. Biological dressings for the management of enteric fistulas in the open abdomen: J Am Coll Surg ; For many years, the application of negative pressure wound therapy NPWT was considered to increase the possibility of fistula formation, but additional studies have demonstrated that NPWT is safe. After 1 day in hospital hospital day 1; HD1Continuous renal replacement therapy was implemented due to acute kidney injury.

At this point, a muscle flap would be created over the fistula alone, as the wound would have already closed.

Management of an Entero-Atmospheric Fistula

All of these methods may result in good outcomes but all require appropriate experience. At some point, a floating stoma was created, and with the impressive healing progress, this became unnecessary. Comparison of outcomes between early fascial closure and delayed abdominal closure in patients enteratmospheric open abdomen: Considerable difficulty was experienced managing EAF in the described patient, primarily due to a lack of experience.

Discussion Figure Reference Figures Fig.

However, the doctors soon decided on a muscle flap rotation and the family opted to go to South Africa. It is one of the most devastating complications of “damage enterotmospheric laparotomy DCL and results in significant morbidity and mortality. Open abdomen with concomitant enteroatmospheric fistula: Temporary abdominal closure was performed after perihepatic gauze packing, resection of 50 cm of small intestine, and preperitoneal pelvic packing.

Sand Schecter WP.

Scand J Surg ; To expedite healing, henceforth daily system changes were recommended. A layer of colostomy paste can be placed under the nipple to ensure a better seal. ETF on initial presentation. A systematic review and meta-analysis. EAF presents a huge challenge and requires a multidisciplinary – surgical, metabolic, nutritional, and nursing – approach.


UK Change Country not listed? Eakin Wound Pouch in place.

It is in fact not a true fistula entsroatmospheric it neither has a fistula tract nor is covered by a well-vascularized tissue. Recently, negative pressure wound therapy was introduced to manage OA.

Enteroatmospheric Fistula Associated with Open Abdomen

A simple novel technique for enteroatmospheric fistulae: 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. Many of the principles applied to classic fiwtula fistulae are used as well. Blood transfusion and warming were immediately instituted. Professional judgment, experience, and teamwork are wnteroatmospheric to successfully managing the patient with EAF.

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. Pacifying the open abdomen with concomitant intestinal fistula: On HD26, a perforation was observed 3 cm below the ileostomy.

Most patients can tolerate some amount of enteral and even oral feeding and do not need to be maintained on PN alone.