“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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Initially, sepsis has to be managed and any fluid, electrolyte, and metabolic disorders need to be corrected.

Component separation technique using an anterior rectus sheath turnover A. Pacifying the open abdomen with concomitant intestinal fistula: It is in fact not a true fistula because it neither has a fistula tract nor is covered by a well-vascularized tissue.

This was in late October. In this regard, an effective nutritional plan entrroatmospheric implemented and fluid intake was increased to about 2.

Discussion Other Sections Abstract I. J Am Coll Surg ; Coronal view abdominal CT scan showing complete infarction of the right kidney B and mesenteric bleeding C. Additionally, we describe our recent proposal of a lateral surgical approach via the circumference of the open abdomen in order to avoid the hostile and granulated surface of the abdominal trauma, which is adhered to the intraperitoneal organs. Professional judgment, experience, and teamwork are key to successfully managing the patient with EAF.

Then, a fistula plug was applied, but it was difficult to fix the plug in the EAF.


Temporary abdominal closure was performed after perihepatic gauze packing, resection of 50 cm of small intestine, and preperitoneal pelvic packing. The AAST American Association for the Surgery of Trauma Open Abdomen Fistyla Group reported that large-bowel resection, large-volume resuscitation, and a greater number of re-explorations were significant predictors of development of a fistula within an open abdomen after trauma.

Management of patients with an open abdomen and an enteroatmospheric fistula is very challenging.

Management of enteroatmospheric fistulae.

Eastern Association for the Surgery of Trauma: UK Change Country not listed? Enteroatmospheric fistula EAF is one of the most devastating complications in patients with an open abdomen and has associated morbidity and mortality rates.

However, he had an open abdomen and an entero-atmospheric fistula developed thereafter.

A year-old male patient was admitted to trauma surgery department after a motorcycle accident. Fistulw interventional laparotomy was subsequently carried out. A baby bottle nipple method was tried and quite successful somedays but fixation of the nipple on the EAF was not easy. Biological dressings for the management of enteric fistulas in the open abdomen: As a result, the spontaneous healing of EAF is nearly impossible.

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It is one of the most devastating complications of “damage control” laparotomy DCL and results in significant morbidity and mortality. In retrospect, the Vaseline gauze barrier between the reticular foam of vacuum assisted closure VAC and open viscera was inadequate, and the sometimes high negative pressure mmHg applied to drain effluent resulted in injury and bleeding of serosa. Nevertheless, treatment involves the following; 1 sepsis must be managed, 2 sufficient nutritional support must be provided, and 3 effluent must be isolated from skin and open viscera.


Collapsible enteroatmospheric fistula isolation device: It should be noted that EAF almost never close spontaneously, and definitive repair usually requires major surgical intervention and abdominal wall reconstruction 6 to 12 months after the original insult. Quality of life after abdominal wall reconstruction following open abdomen. The progress during the month of September was impressive and wound closure was imminent. This way leakage was avoided.

A layer of colostomy paste can be placed under the nipple to ensure a better seal. The occurrence of an enteric fistula in the middle of an open abdomen is called an enteroatmospheric fistula, which is the most challenging and feared complication for a surgeon to deal with.

Management of an Entero-Atmospheric Fistula

Prevention is clearly the best treatment strategy but may be difficult to achieve. As from 15th August, the management of the entero-atmospheric fistula involved ensuring that the wound size continued to decrease.

December31 3. Segmental resection of the perforated bowel was performed successfully. New Care Management Plan: Cyanoacrylates fnteroatmospheric be beneficial for small EAFs, especially as an adjunct to primary suturing.