Creative Managaement of an Enteric Fistula

This patient had a failed abdominal hernia repair resulting in a non-functioning colostomy but a mid-line open wound with a matured producing fistula.   The peri-fistula full thickness wound, needed to be protected from effluent.  A pouching system was needed to heal the skin and contain the effluent.            Pattern of the wound site, should be ¼ inch larger than the wound’s edges.  Ostomy paste was applied around the outer edges of the wound, preventing effluent from undermining the wafer.  Repeatedly this failed, even with continuous wall suction, which closed the pouch’s anterior surface over the fistula, causing a pooling of effluent, resulting in leaks.            Needing to bridge the fistula, so liquid effluent is directed toward the pouch’s spout, lead to brainstorming.  An infant’s oxygen mask has some firmness to withstand the vacuum pressure, and a soft, low pressure surface that conforms to the skin’s surface.  Patient’s effluent dumped 300 ccs of output every 40 minutes, overwhelming the system resulting in leaking.  Pt stated, “We need a cup collecting the output, until it drains toward the spout.”  One side of a Styrofoam cup was cut and fitted around the exposed bowel, and over the distal end of the infant facemask, then a Red Robinson catheter was placed near fistula’s opening and threaded through a hole cut into the bottom of the Styrofoam cup.  The catheter’s distal end was placed inside the pouch’s spout, directing effluent toward the suction canister. The suction was set to maintain suction without excessive pressure on the facemask. 

Wear time increased from 1-2 days to 3- 6 days, resulting in healing enough for corrective surgery in a couple of weeks.  Surgical outcome left scar tissue and small chronic wound, which continues healing with wound therapy.  Colostomy is now functioning.  He spent 9 months in hospitals, before returning home.