Bedside management of an abdominal wound containing an enteroatmospheric fistula: a case report

Enteroatmospheric fistulae (EAF) - unnatural connections between the bowel and the outside environment - are a feared complication of major abdominal operations. EAF pose a life-threatening risk to patients already weakened by surgical insult by altering fluid and electrolyte balance and fostering malnutrition. The authors describe a method of wound management for a 64-year-old morbidly obese woman with a history of coronary artery disease, diabetes mellitus, and bipolar disorder who developed a large abdominal wound containing multiple high-output EAF after an incarcerated abdominal hernia repair, wound infection, and subsequent laparotomy and lysis of adhesions followed by graft placement and negative pressure wound therapy. The volume, consistency, and location of the EAF caused commercial negative pressure devices to fail and simple gauze dressings were ineffective in maintaining a clean wound base and containing odor. Effluent collection and wound healing was achieved utilizing a modified method of EAF management that included two connecting rubberized catheter drains and continuous wound irrigation with wall suction and cotton gauze for debridement. Surgical EAF closure was successful after 6 months of care. This method provided a satisfactory balance between the diagnosis of EAF and the readiness to meet the physiologic demands of definitive surgical treatment.