A 48 year old male was admited to ICU with abdominal pain and complications related to gastric bypass/Roux en-Y surgery performed in 2001. Diagnoses included peritonitis with gastric remnant performation. He underwent emergent exploratory laparotomy with primary closure of gastric remnant with omental flap. One month later after forceful coughing the patient sustained wound evisceration, perforated small bowel loop, and abdominal rupture of jejunum with significant omental bleeding. Subsequently, this resulted in formation of two colocutaneous fistulas within a large open abdominal wound.

Past Management

After 3 days of wound management with vacuum-assisted therapy, the fistulas began functioning, threatening to comtaminate the wound. Initial fistula pouching attempts directly to the vac foam failed to isolate the fistulas from the wound.

Current Approach

By simultaneously pouching with deep convexity as vacuum suction was applied, we successfully isolated the fistulas from the wound. This unique approach, along with close nutritional assessment, has promoted progressive abdominal wound healing. Following an exhaustive review of the literature it was noted that this unique technique had not previously been reported.

Patient Outcomes

Using negative pressure therapy and pouching the colocutaneous fistulas using deep convexity successfully confined effluent production. Gradual granulation of the wound is occurring with wound dimensions decreasing. This unique wound care approach and ongoing collaboration of the multidisciplinary team have resulted in optimal healing for this patient with a complex abdominal wound.

Conclusions

This phenomenal case study of a patient who sustained grave and life-threatening complications, posed many challenges. Wound healing has been significant with combined use of negative pressure assisted therapy and pouching with deep convexity.