Improved Control of Exposed Fistula in the Open Abdomen

Abstract

F a c n exposed (enteroatmospheric) fistula is the most devastatng complication of the open abdomen. This type of fistula is aused either by accidental trauma to exposed bowel or by an nastomotic leak. It is essentially a hole in the gastrointestinal ract draining into the open peritoneal cavity. An exposed istula is very difficult to control and is often impossible to epair because it is not enterocutaneous: there is no tract, and he opening is not surrounded by skin. In addition, the open ranulating “frozen” abdominal visceral mass precludes resecion or exteriorization of the involved segment. The exposed istula results in uncontrolled spillage of intestinal content into he open abdominal wound, with ongoing sepsis and a treendous catabolic insult in an already physiologically comromised patient. Proposed technical solutions to control the effluent from an xposed fistula include various forms of tube drainage inside r around the fistula opening, a “floating stoma,” in which he edge of the perforation in the gastrointestinal tract is suured to a circular opening created in the plastic silo used to over the abdominal defect, or continuous irrigation of inacessible duodenal leaks. Recently, vacuum-assisted wound anagement has been described as a useful adjunct in the anagement of enterocutaneous fistulas. But control of an xposed fistula remains a formidable challenge, especially if here is more than one fistula opening, as is often the case. one of the currently available techniques provides optimal ontrol of the fistula output. We describe a simple atraumatic technique to control exosed fistulas using a combination of tube drainage and acuum-assisted wound management.