A case study in creativity and patience: healing an enteroatmospheric fistula in an open abdominal wound

The purpose of this poster is to describe an innovative approach to successful management of a complex wound in and obese, diabetic post surgical patient.

An enteroatmospheric fistula (EAF) is an exposed fistula in an open abdominal wound with no surrounding soft tissue (Schecter, 2012).  It presents a challenge to the wound nurse to contain the fistula drainage and divert it from the open wound bed.

 M.G., a 51 year old female with a history of ulcerative colitis, status post total colectomy with end ileostomy in 2009, and a partial proctectomy in 2012. Her last procedure was complicated by wound dehiscence and development of an EAF on post operative day 10.  

The wound measured 25.5 cm (L), 12cm (W) 7 cm (D) with a fistula measuring 9 cm deep at the apex of the wound. An innovative approach using a negative pressure dressing and a prescriptive combination of advanced wound care products was implemented.  This created a separation of the fistula from the dehisced wound allowing it to heal.

The method used was a specific layering of the following materials:   border strip of white foam, occlusive petrolatum gauze, hydrofiber dressing and an extra thin piece of hydrocolloid. This created a seal against the end of the standard black foam, maintaining negative pressure to the dehisced wound. The fistula was successfully contained with a separate dressing and a suction catheter.

On hospital day 42, wound healing was evident: the wound measured 21cm (L), 7 cm (W), 0.5 cm (D).  The fistula (7cm) remained open and was pouched. The negative pressure dressing was discontinued and the patient was discharged to home on hospital day 57 with a healing wound.  Clinical creativity and patience proved successful for this patient. 

Schecter, W. (2012, 10 16). Principles of management of enteric fistulas. Retrieved from www.uptodate.com