Petaling Around a Fistula: A Case Study

Introduction: The development of a fistula presents physical and psychological management difficulties for the patient. The patient and family frequently request immediate surgical intervention. Researchers have discovered that fistula recurrence after take down surgery is much lower in individuals who wait at least 6 months for the repair. ⁽¹⁾  In the interim, the WOC nurse serves a pivotal role within a multidisciplinary team in managing the fistula during this transitional period. ⁽²⁾

Clinical Problem: A 64 year old female with a history of Crohn's disease, multiple abdominal surgeries, and ileostomy developed wound dehiscence with intra-abdominal sepsis and fistulae after a cholecystectomy and hernia repair. She developed sepsis during her hospitalization, requiring additional surgical intervention to drain an abscess and extended wound debridement. Post-surgical WOC nursing challenges included a large wound, unfavorable fistulae location, obesity, high volume output, multiple pouched sites, and frequent pouch leakage.    

Clinical approach: Comprehensive clinical management included developing a complex pouching system consisting of a large fistula pouch with “petaling” technique of hydrocolloid skin barrier wedges. ⁽³⁾  Appropriate pouching system with “petaling” offers enhanced perifistular skin protection and stability of soft abdominal contours. Additionally, containment of effluent, odor control and strict monitoring for intake and output was achieved.

Outcome:  During her 8 month waiting period for surgery, WOC nurses successfully managed the complex “petaled” fistula pouching system to obtain a 4 day wear time while maintaining intact perifistular skin. She was taken for fistula closure with diverting loop jejunostomy. Three months later, the stoma was reversed and she recovered without complications. In conclusion, the “petaling” technique contributed to better wound/fistula management with increased mobility and overall physical and psychological satisfaction.