Enterocutaneous fistula management : advantage combining hydrocolloid dressing , alcohol free paste, two-piece pouching system with negative pressure suction,

PROBLEM STATEMENT: This 86year-old female patient had been diagnosed as having adenocarcinoma of cecum and villous adenoma over the sigmoid colon. She received right hemicolectomy and low anterior resection on 2002.2.19. She had intestinal obstruction postoperatively and received multiple subsequent operation. This time, she was admitted for wound debridment and possible closure. Unfortunately the wound was still poor healed and enterocutaneous fistula formation was noted. Large amount of discharge was noted. The fluid caused wound poor healed and surrounding skin maceration with malodor. Due to painful sensation, this patient had insomnia during the night and poor life quality. PAST MANAGEMENT: Previously this kind of wound required gauze exchange frequently. It took the paramedical to exchange the dressing every 2 or 3 hours for her. The one-piece pouch leaked one to two times a day. Medical waste can't be avoided. CLINICAL APPROACH: Processes in 2009.09 involvements to apply thick hydrocolloid dressing strip piles up one on top of another alternately around the wound edge, make the past in the slit place to fill. I use the transparent polyurethane film dressing cover in the thick hydrocolloid dressing. I apply 102 two piece foundation tailor is bigger than the wound 0.2cm pastes to attach around the wound, strengthens fixedly by the belt, around the fistula wound fills by the and the tube exports the 28FrF/S negative pressure suction, changed pouch approximately every 3-5 days. OUTCOMES: This skin maceration was improved. Meanwhile, the fluid amount and the odor could be monitored. In this approach, dehydration and electrolyte imbalance wound be avoided. By decreasing the frequency to exchange dressing, the patient had better life quality. Finally, the caregiver handled well the skill. This patient was discharged quickly and finished her 6 month hospital course. CONCLUSIONS : This approach was effective for the wound that the fistula was within the dependent part of the wound with moderate amount of discharge.