Wound Care Challenge: Management of an Enterocutaneous Fistula

Statement of Clinical Problem:  Patient is a 55 year old female s/p resection of abdominal wall desmoid tumor 20 years ago and presents with large abdominal wall hernia. Patient underwent ventral hernia repair with open gastric bypass procedure and developed post op wound dehiscence related to development of multiple enterocutaneous fistulae. Patient returned to OR for complex wound closure with mesh, skin substitute and vaccuum-assited closure. Management of the existing fistula in this manner proved to be unsuccessful, abdominal wound was re-opened, and WOC nurse consulted for wound management.

Current Clinical Approach: WOC nurse evaluation revealed a wound that measured 20 cm (l) x 18 cm (w) x 6cm (d) and fairly clean with 30% adherent necrotic tissue. In hopes of spontaneous wound closure, patient was NPO and on TPN therapy to rest the bowel. Fistula drainage remained at over two liters a day. Multiple pouching devices and techniques were trialed and proved to be unsuccessful in managing the fistula drainage, wound size and associated periwound drains. A fistula / wound management system was trialed that fit the wound appropriately, was able to manage the high output, and accommodate the periwound drains. The system was attached to low wall suction until the fistula output became more manageable.

Patient Outcome: The patient’s fistula output continued to decrease, the fistula / wound management system continued to work well and provided a four day wear time. The WOC nurses worked with the home care agency in formalizing a realistic discharge plan for this patient. This collaborative effort resulted in a timely patient discharge to home with successful home care nursing management of this complex patient.  

Conclusion: The fistula / wound management system proved to be a viable solution in the successful management of this high output fistula.