Drainage Management of Enterocutaneous Fistula within an Abdominal Wound

Drainage Management of Enterocutaneous Fistula within an Abdominal Wound            Management of complex post-operative wounds with fistulas continues to be a challenge for clinicians.  Multiple wound sizes and uneven abdominal contours create pouching nightmares.  Containment of drainage and protection of the peri-wound skin is imperative.  NPWT is one way to manage fistula drainage while promoting wound healing.             RD is a 61 year old with a history of bladder cancer.  He is post cystoprostatectomy with ileal-conduit creation.  Post operative complications included failure of the ureteral anastomosis and drainage of fecal material from the incision.             The wound and ostomy team was consulted for management of a high output  fistula located in the wound bed.  Upon assessment the wound base had thick green effluent drainage with visible sutures.  NPWT was initiated using a round channel drain with suction at 80 mmHg.             Due to increased viscosity of the effluent drainage, the round channel drain was unable to accommodate the thicker drainage.  Attempt then was made to place two drains, one being a flat JP type drain, and the second a 24 French chest tube.  With this system we were able to obtain a 2 day wear time.  The drainage continued to thicken, making it difficult to maintain a seal.  Pouching was then initiated enabling the wife to manage the wound and drainage at home.            The flexibility of using NPWT allows for different types of drainage tubes to be used.  When thicker drainage is not accommodated by smaller bore drainage tubes, NPWT can easily be adapted to a larger size drainage tube.