“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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A born gentleman presented at the hospital with intestinal obstruction and a parastomal hernia.
An interventional laparotomy was subsequently carried out. The patient later developed an entero-cutaneous fistula, which was managed in due course.
However, he had an open abdomen and an entero-atmospheric fistula developed thereafter. At the time of my intervention, the entero-atmospheric fistula ETF was being managed by negative wound pressure therapy NWPT with little success.
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.
This way leakage was avoided.
Enteroatmospheric fistula: from soup to nuts.
With this new approach, it was intended that granulation would occur, as faecal content does hinder the process. Over the next three weeks, these measures were introduced and the patient was discharged on 31st July. The pouching system was changed on alternate days.
Wound size had markedly reduced to a bare minimum 2cm in enteroatmosperic down from 10cm. This was how the wound was managed to ensure wound closure and thereafter the fistula should close spontaneously. To expedite healing, henceforth daily system changes were recommended.
Management of an Entero-Atmospheric Fistula
As from 15th August, the management of the entero-atmospheric fistula involved ensuring that the wound size continued to decrease. At some point, a floating stoma was created, and with the impressive healing entsroatmospheric, this became unnecessary.
At the same time, wound healing was prompted, fistula output could be effectively monitored and the patient was able to be mobile. ETF healing is normally expedited by a combination of effective wound management and nutritional input. In this regard, an effective nutritional plan was implemented and fluid intake was increased to about 2. The progress during the month of September was enteroatmospherjc and wound closure was imminent.
There were two options available to us; either to allow the small wound left pictorial available to close spontaneously or for enteroatmospherric plastic surgeon to do a muscle flap.
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After seeing how much progress had been made, the plastic surgeon was of the opinion that the existing care plan should continue until maximum closure occurred. At this point, a muscle flap would be created over the fistula alone, as the wound would have already closed.
Following this advice, I continued with the existing care plan. However, the doctors soon decided on a muscle flap rotation and the family opted to go to South Africa.
This was in late October. 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 photos were taken over a period of 3 months. I first saw the patient in July, and I stopped my management in October.
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