The successful management for long-term intractable enteroatmospheric fistula: A case report

Abstract

Introduction Efficacy of open abdomen management with negative pressure wound therapy for enteroatmospheric fistula has been performed. But, few reports have shown its utility for enteroatmospheric fistula several years after onset. Presentation of case A 46 year-old woman underwent total colectomy due to total ulcerative colitis in her twenties. Three years before the onset of enteroatmospheric fistula, she underwent simple total hysterectomy for uterine smooth muscle tumor. Small bowel obstruction occurred early and a small bowel bypass was performed. However, she had sudden abdominal pain and was diagnosed with anastomotic leakage of small bowel bypass. Although antibiotic treatment was initiated, infection was difficult to control, and a midline abdominal incision was performed, followed by the formation of enteroatmospheric fistula. She declined early surgical intervention and started receiving home parenteral nutrition with antibiotic treatment. Although central vein management was continued, catheter infection became frequent. Hence, surgical intervention was planned 30 months after the formation of enteroatmospheric fistula. Two-stage abdominal wall reconstruction using open abdomen management with negative pressure wound therapy was planned. The definitive abdominal wall reconstruction was performed 14 days after the initial operation. Finally, she was discharged without reoperation. Discussion Enteroatmospheric fistula has no overlying soft tissue and no real fistula tract. Besides these complications, there were complications of the scarred abdominal wall from intestinal fluid exposure for 30 months. Conclusion The strategy using open abdomen management with negative pressure wound therapy for long-term enteroatmospheric fistula will have a good postoperative outcome with the same as early intervention.

Factors Associated with Management Outcomes of Enterocutaneous Fistula Patients at the University of Dodoma Affiliated Teaching Hospitals

“…These cumulative observations underscore the persistent challenges in managing ECF and the need for concerted efforts to improve patient outcomes across different geographical contexts. In contrast, lower mortality rates were reported in settings such as Switzerland, Spain, and the UK, where the observed rates were all under 10% [25,26]. This discrepancy may be attributed to the more affluent healthcare environments and advanced medical technology platforms available in those regions [27][28][29][30].…”

Effectiveness of Fistuloclysis in Nutritional Management of Enteroatmospheric Fistulas: A Retrospective Study at Santo Tomás Hospital, Panama

“…Enteroatmospheric fistulas (EAF), a particularly complex subtype of enterocutaneous fistulas, pose significant challenges in surgical management. These complications, characterized by a high mortality rate of 42%, arise in patients lacking adequate skin coverage over the viscera, thereby creating a direct communication of enterotomy with the atmosphere [ 1 - 3 ]. Their treatment demands a multidisciplinary approach to ensure optimal outcomes, requiring significant commitment from the entire healthcare team.…”