The Management of Enterocutaneous Fistulae Using a Portfolio of Customizable Fistula Isolation Devices

Introduction: Enterocutaneous fistulae (ECF) represent aberrant communications between the intra-abdominal gastrointestinal tract and the skin/wound, which is associated with significant morbidity and mortality. ECF classification affects fistula closure and requires a multidisciplinary approach to resolve.^1,2 At this cancer center, the ostomy nurse used customizable, one-piece compressible fistula isolation devices to divert effluent from the wound bed and isolate ECFs in two patients (Pt).

Methods: Non-adherent dressings were used as wound base contact layers prior to ECF isolation. The first case used a fistula appliance to accommodate the ECF opening, while the second case used a flexible isolation strip and an effluent diversion appliance for ileostomy sequestration. Negative pressure wound therapy (-50 to -75 mmHg) was applied over the wounds to promote development of granulation tissue. No malignancy was present in the wounds treated by NPWT.

Results: Pt one was a 61-year-old obese female with heart failure, who underwent a hysterectomy and developed a small bowel fistula through her incision (Day 28). After 3 weeks of fistula management, she transitioned from total parenteral nutrition (TPN) to a soft diet before home discharge. A 6-week home healthcare service plan encompassed applying zinc-based skin protectant, hydrofiber dressings and adhesive wound dressings to be changed daily. The ECF closed spontaneously 6 weeks post-discharge. Pt two was a 69-year-old obese female with recurrent endometrial cancer, treated via surgery and chemotherapy. She underwent an exploratory laparotomy with extensive enterolysis, small bowel resection with side-by-side anastomosis and incisional hernia repair. An ECF developed after a second exploratory laparotomy to resolve large bowel leakage. Following ileostomy management with fistula appliances and transitioning from TPN to a low fiber diet, the patient was prepared for discharge to a rehabilitation facility.

Conclusion: In these two cases, fistula isolation modalities were integral to a comprehensive ECF management protocol.