Management of enteroatmospheric fistula thanks to new isolation technique

Abstract

We aimed to present our method called as new isolation technique with stopper (NITS) to manage enteroatmospheric fistula (EAF) in an open abdomen (OA). The patient was a 71-year-old male with Hartmann colostomy and incisional hernia. A dual mesh was used for incisional hernia repair after colorectal anastomosis. The patient was urgently re-admitted to hospital due to EAF on the postoperative 30th day. The NITS application was performed twice at different times. General anesthesia was not required for the applications, but sterile conditions in operation room were provided. A Penrose drain was sutured with 5/0 polydioxanone onto the mucosa of EAF orifice. A small pool was created to protect enteric content from leakage. The leak test was performed by spilling saline into this pool. The sponge with visceral organ protector around the pool was adhered by adhesive sterile drape, and one opening was performed on drape. Negative pressure therapy was launched with-75 mmHg in continuous form. EAF was isolated from the OA wound and sponge with the help of stopper performed with adaptable and obstacle ring paste. After these two applications, EAF was converted to stoma. The anastomosis of small intestine was performed 45 days later. In our NITS system, control of EAF may be successfully provided besides prevention of loss of enteric fluid and electrolyte. Advantages of NITS: 1) Successful control in all types of EAF is possible with NITS. 2) The required material for NITS system can be found easily. 3) All types of EAF can be converted into stoma in a short time. Consequently, the therapy of EAF in Björck 4 OA patients may be carried out successfully with NITS method.

Nueva técnica para control de contaminación de fístulas enteroatmosféricas en abdomen abierto Björck 4. Método de Capilaridad (MECA)

“…Este último método se ha combinado con otras técnicas como la FISPME (fistula isolation by suturing the Penrose drain to mucosa of orifice of entero-atmospheric fistula) descrita por Yetisir et al, en la cual se utilizó un solo dren de Penrose corto suturado al borde de varias fístulas en conjunto para aislar su producción, mientras que el área periostomal se protegió con sistema VAC 12 . Eğin et al, modificaron esta técnica y la denominaron NITS (new isolation technique with stopper), en la cual, luego de suturar un dren de Penrose corto al lumen intestinal, se ocluye la fístula con un apósito hidrocoloide y se utiliza un VAC en el área periostomal 13 . En ambos trabajos se lograron desenlaces favorables.…”

Apendektomiye Bağlı Bridektomi Sonrası Gelişen Enteroatmosferik Fistülün Yönetimi

“…Surgical treatment is mostly multi-phased. Following an accurate confirmation and classification, it requires individualized treatment considering EAF type and characteristics (Di Saverio et al, 2016;Eğin et al, 2019). The most definitive surgical method is the resection of the bowel containing the fistula opening.…”

“…A resection surgery may not be possible due to common peritoneal adhesions (frozen abdomen). In this case, it is essential to control EAF leakage (Eğin et al, 2019;Wirth et al, 2018;Wright and Wright, 2011). As an out-of-control EAF leakage sets back wound recovery due to constant contamination around the irritation of the skin (Eğin et al, 2019).…”

“…In this case, it is essential to control EAF leakage (Eğin et al, 2019;Wirth et al, 2018;Wright and Wright, 2011). As an out-of-control EAF leakage sets back wound recovery due to constant contamination around the irritation of the skin (Eğin et al, 2019). Frozen open abdomen complicated with EAF is classified as Björck 4 open abdomen (Björck et al, 2016).…”

Delayed primary fascia closure of Björck grade 4 open abdomen with enteroatmospheric fistulas after repeated surgery for adhesive small bowel obstruction: a case report

“…The most severe, grade 4, is defined as “frozen OA with adherent/fixed bowel, unable to close surgically, with or without fistula”; thus, only delayed skin closure with a skin flap or a skin graft are possible closure options [ 2 ]. There are few reported grade 4 OA cases with successful primary fascia closure and the complete removal of enteral adhesions [ 4 ][ 5 ][ 6 ]. To the best of our knowledge, no case has been reported in the literature of primary fascia closure for grade 4 OA after repeated laparotomy.…”