Spit Happens: Managing an Esphagostomy

Spit Happens! Managing an Esophagostomy

Topic: An esophagectomy is an excision of part of the esophagus that is performed for esophageal cancer, swallowing disorders and trauma. One of several complications that can occur is an anastomotic leak. When a leak occurs an esophagostomy may be surgically created and require a pouching system to contain secretions.  Sometimes these are referred to as a ‘spit fistula.’ 

Purpose: The main purpose of this project is to demonstrate the use of ostomy pouches as a viable option when drainage control is necessary for a spit fistula.   

Objectives: A spit fistula is generally located in the left lower neck or clavicle area. If drainage is small, it may be managed with application of an absorptive dressing. Moderate or large amounts of drainage benefit from the application of a pouch to contain drainage, reduce skin irritation and improve the quality of life for patients.

Outcomes: The creation of a spit fistula for an anastomotic leak following an esophagectomy may require the application of a pouch to contain moderate to large amounts of drainage. Patients may have the spit fistula for several months as infections are treated and incisions allowed to heal.  A gastrostomy tube is inserted to provide for the patient’s nutritional needs.  Several attempts with different pouches may be necessary to find a correct fit. The pouching system generally requires changing every 3-5 days with the majority of patients receiving a four day wear time.  Containment of drainage prevents skin from becoming macerated and denuded. Drainage containment also keeps the patient’s gown or clothing dry and may allow palliative food or fluid intake which can create a feeling of normalcy under very difficult circumstances.