A simple device for closure of a colocutaneous fistula within the laparotomy wound: a case report

Colocutaneous fistulas within laparotomy wounds are rare and difficult to treat. Surgical repair may be contraindicated or not desired and negative pressure wound therapy may not be successful. A simple device made from a silicone, flexi-aid hand exerciser was used to close a colocutaneous fistula within the laparotomy wound of a 50-year old man following surgery of an esophageal carcinoma and a surgical history of Whipple's procedure for adenocarcinoma of the ampulla of Vater. His wound developed 9 days postoperatively, measured 8 cm x 3 cm x 2 cm, and was contaminated with fecal material. Initial efforts involving cleansing and the use of negative pressure wound therapy were unsuccessful and the patient refused additional surgery. In this patient, a silicone occlusion device, used in conjunction with a silver hydrofiber dressing, prevented fecal soiling and facilitated closure of the colocutaneous fistula and the laparotomy wound. He was discharged on postop day 22 and healed by postop day 64. This was the first time this approach was used. Studies to optimize nonsurgical management approaches of these complicated conditions are needed.