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Non-surgical management of an enterocutaneous fistula in an irradiated abdomen poses the
following challenges:
- Effluent containment and control
- Peri-fistular skin protection
- Patient return to home with restoration of physical function and comfort
- Cost effective management options.
The addition of Hyperbaric Oxygen Therapy (HBOT) in the treatment plan for the abdominal
wound was evaluated.
Patient Example:
This active 61-year old female had a history of granulosa cell tumor, diagnosed in 1988.
Multiple recurrences were treated with additional surgeries, chemotherapy and heavy doses of
radiation therapy. The most recent surgery (July, 2011) resulted in the development of numerous
enterocutaneous fistulae, originating from the anastamosis site. Surgical revision was no longer
an ideal option. The abdomen presented with numerous radiation tattoos and an uneven scarred
surface with deep skin folds. At the time of referral, Negative Pressure Wound Therapy (NPWT)
was the method of treatment. The patient’s husband was changing the dressings. The wound
measured 4.7cm long by 0.3 wide by 3cm deep with undermining at 12:00 o’clock that was 6.6
cm deep. Deep sutures were visible in the wound base and the tissue was dull grey in color. Fecal
red tinged drainage exceeded 240 cc daily. Periwound skin was painful, red and denuded.
Clinical Approach:
A two-piece pouching system and silver dressings were ineffective in managing containment.
Periwound skin continued to deteriorate. Flexible wound and fistula management pouches were evaluated.
Outcomes:
After 12 HBOT treatments, the fistula output decreased markedly and the wound size decreased
by half. The pouch remained intact for 4-7 days, providing effective effluent containment, and
was not affected by HBOT. The patient reported no difficulty obtaining home use supplies,
despite being from a rural area and that effective fistula management allowed her to be able to
participate in desired social activities