Conversion of an Enterocutaneous Fistula Associated With an Open Abdominal Wound Into a Drain-Controlled Enterocutaneous Fistula

Colleen M. Trevino, RN, NP, PhD; Amy Verhaalen, RN, MSN, APNP, ACNP; Marie L. Bruce, APNP; Travis Webb, MD, MHPE

Disclosures

Wounds. 2014;26(2):43-46. 

In This Article

Abstract and Introduction

Abstract

Open abdominal wounds with enterocutaneous fistulae present health care providers and patients with complex wound management issues. Frequently, large wounds with exposed bowel are present and require the utilization of multiple wound care modalities to provide a method of control and isolation of fistula effluent to allow for maximum wound healing. This case study presents a unique approach to management of low-output enterocutaneous fistula with an open abdominal wound. Through the use of negative pressure wound therapy, a standard surgical drain, and optimized nutrition, fistula drainage was redirected and the abdominal wound healed, leaving a drain-controlled enterocutaneous fistula.

Introduction

Open abdominal wounds with associated enterocutaneous fistulae provide some of the most complicated wound management challenges for patients, physicians, and nurses.[1] In contrast to an enterocutaneous fistula not associated with a large open wound, an enterocutaneous fistula with an open abdominal wound provides unique challenges because of the additional concerns of open fascia and exposed bowel. These fistulae are frequently surrounded by adherent bowel in various stages of healing without an appropriate surface for placement of an appliance to control the fistula drainage. Control of fistula drainage and protection of surrounding tissue and skin is a principle of early fistula management.[2]

Options for wound care and fistula management have expanded as new techniques have been reported and health care teams with advanced experience and interest have developed. One of the greatest advances in recent years has been the innovative use of negative pressure wound therapy (NPWT) devices to aid in control and healing of complex abdominal wounds.[3,4] This case report describes a unique method to convert an enterocutaneous fistula into a manageable drain-controlled enterocutaneous fistula, allowing for separate abdominal wound healing using an NPWT device.

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