Creative and Effective Fistula Mangement

Fistula management is a challenging part of the WOC’s role. These case studies examine patients that were effectively managed resulting in wound healing, drainage containment, preservation and /or restoration of perifistula skin, ease of patient care and improved quality of life. Digital wound photos will be included on poster.

Mrs. M, 60 year old white female,from OSH s/p ileostomy/Hartman Pouch creation due to anastomotic breakdown, peritonitis.

• 7/08 repair enterocutaneous fistula; repair of bladder injury; SBR with end to end anastomosis; repair of post incision ventral hernia.
• Several days later the wound dehisced in the mid-portion with green effluent, wound opened and a pouch over the entire wound/fistula for several weeks.
• OR for fistula repair failed again, NPWT with fistula isolated into ostomy pouch until considerable healing then OR again for fistula closure.

Mr.O, 67 year old African male transferred from OSH s/p SBO with complicated abdomen, no comorbitities

• large abdominal incision with retention sutures, proximally open wound with fistula at 10 o’clock margin with fecal drainage
• initially ostomy pouch to isolated fistula attempted for several days
• wound manager pouch applied to entire abdomen to contain drainage for one week
• OR, wound opened, irrigated, left open for packing
• NPWT began with isolation of fistula to ostomy pouch to wall suction, successfully until graft for closure

Ms.M, 65 year old black female s/p ventral hernia repair 7/08. Comorbitities: obesity, IDDM, ileostomy d/t UC.

• dehisced abd incision with fecal drainage, complex small intestinal fistula
• need for drainage containment, ease of use for pt/care giver with limited resources
• wound manager pouch applied, two manufacturers were attempted, with addition of strip paste
• pediatric pouches to 2 fistulas also trialed
• longest weartime achieved with basic ostomy pouch with barrier ring
• pt discharged to SNF with simple POC awaiting next surgery for fistula repair