Combining Traditional Ostomy Products with a Cyanoacrylate-based Monomer to Isolate an Enterocutaneous Fistula

Problem: A 39 yo male with fistulizing Crohn's disease is s/p exploratory laparotomy, celiotomy and resection of small intestine. Post op complications include a large dehisced midline abdominal wound with a high output enterocutaneous fistula in the distal section. Several months of hospital care was required due to fistulas, sepsis and malabsorption.

Methods: The WOC nurse was consulted to manage the fistula. In collaboration with the surgeon, it was agreed that negative pressure wound therapy would heal the wound if we could isolate the fistula. Several failed methods of management were tried including wound managers, fistula devices and building a wall using barrier rings. Through a unique discovery, the WOC nurse found a new approach using ostomy powder in the base of the wound and sealing with a cyanoacrylate monomer. This procedure left the base of the wound dry and allowed for barrier rings to be used as a surface to pouch the fistula. After isolating the fistula, negative pressure wound therapy was successfully used to heal the wound.

Conclusion: The application of a combination of ostomy powder and cyanoacrylate monomer allows for effective isolation and pouching of a high output fistula. The patient was discharged with a healed wound and able to independently manage his fistula. This procedure is now widely used in our hospital system by WOC nurses and surgeons.