“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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Management of enteroatmospheric fistulae.

Sign up for Eakin updates. Subsequently, wound crown method was applied to divert effluent enteroatmosheric EAF, 2 but failed because perforation sites adjoined the abdominal wall. Coronal view abdominal CT scan showing complete infarction of the right kidney B and mesenteric bleeding C. The photos were taken over a period of 3 months.

At some point, a entteroatmospheric stoma was created, and with the impressive healing progress, this became unnecessary. Negative-pressure wound therapy for critically ill adults with open abdominal wounds: World J Emerg Surg ;8: Enteroatmospheric fistula EAFa special subset of enterocutaneous fistula ECFis defined as a communication between the gastrointestinal GI tract and the atmosphere. He remained in a bedridden state awaiting pelvic surgery.

Management of an Entero-Atmospheric Fistula

Discussion Figure Reference Enteroatmospheric fistula EAF is one of the most devastating complications in patients with an open abdomen and enteroatmospehric associated morbidity and mortality rates.

Discussion Figure Reference Figures Fig. The pouching system was changed on alternate days. Considerable difficulty was experienced managing EAF in the described patient, primarily due to a lack of experience.

Nevertheless, treatment involves the following; 1 sepsis must be managed, 2 sufficient nutritional support must be provided, and 3 effluent must be fiwtula from skin and open viscera. Attempt to rationalize the approach to a surgical nightmare and proposal of a clinical algorithm.


Their etiology is complex and ranges from persistent abdominal infection, anastomotic leakage, adhesions of the bowel to itself or fascia, and repeated bowel manipulation during return trips to the operating room or dressing changes.

Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging. Small bowel fistulas and the open abdomen. J Trauma Acute Care Surg ; Ileostomy and the perforation were resected emergently and a stoma was created at midline Fig.

I first saw the patient in July, and I stopped my management in October. Search for Search All Journals. The patient remained on total parenteral nutrition for 6 months and was then transferred to other hospital for definitive surgery. Then, a fistula plug was applied, but it was difficult to fix the plug in the EAF. On HD2, right nephrectomy was performed due to complete infarction of the right kidney, but abdomen closure was unsuccessful due to severe bowel edema.

It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue.

New Care Management Plan: However, on HD10 wound dehiscence occurred. After 1 day in hospital hospital day 1; HD1Continuous renal replacement therapy was implemented due to acute kidney injury. Initially, sepsis has to be managed and any fluid, electrolyte, and metabolic disorders need to be corrected. Int Wound J ; Sand Schecter WP.

Petroleum impregnated gauze or clear Telfa sheet is then placed over the bowel and the entire wound is covered using a commercial VAC dressing. ETF on initial enterkatmospheric.

This way leakage was avoided. This was how the wound was managed to ensure wound closure and thereafter the fistula should close spontaneously. At this point, a muscle flap would be created over the fistula alone, as enteriatmospheric wound would have eteroatmospheric closed. What is the effectiveness of the negative pressure wound therapy NPWT in patients treated with open abdomen technique? Discussion Figure Reference Considerable difficulty was experienced managing EAF in the described patient, primarily due to a lack of experience.


The progress during the month of September was impressive and wound closure was imminent. In this regard, an effective nutritional plan was implemented and fluid intake was increased to about 2. On HD24, symptoms of peritonitis appeared and exploratory laparotomy was undertaken. When treating patients with risk factors, efforts should be made to prevent EAF enterotmospheric and devise better techniques for diverting effluent.

Lateral incisions were made to close skin at the midline incision B. Comparison of outcomes between early fascial closure and delayed abdominal closure in patients with open abdomen: Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: No gold standard therapy has been established for the treatment of EAF, and thus, treatment decision making is enteroafmospheric on the experience of medical staff.

Enteroatmospheric fistula: from soup to nuts.

A baby bottle nipple method was tried and quite successful somedays but fixation of the nipple on the EAF was not easy. Wound size had markedly reduced to a bare minimum 2cm in diameter down from 10cm.

A small hole is shaped into the VAC sponge ehteroatmospheric hold the nipple in place. Scand J Surg ; ETF healing is normally expedited by a combination of effective wound management and nutritional input.

Intensive care support of organs and systems is vital in order to manage the severely septic patient and the associated multiple organ failure syndrome.