Management of Enteroatmospheric Fistula with Negative Pressure Wound Therapy

Background and Purpose: Enteroatmospheric fistula (EAF) is one severe complication of laparotomy. Negative pressure wound therapy (NPWT) has been successfully employed to manage numerous wounds, but probably contraindicated in an open abdomen (OA) wound due to its risks of increasing EAF incidence. This case report aims to explore the possibility of using NPWT to manage EAF in a patient with OA. Case Description: Mrs. A. was a 42 year old patient admitted to Lovelace Women’s Hospital, Albuquerque, New Mexico, on 12/19/2014 for robot-assisted laparoscopic vaginal hysterectomy. On 12/22/2014, the patient underwent midline laparotomy for bowel resection, drainage of fecal peritonitis, cleanse of contaminated abdominal cavity and removal of abdominal wall mesh due to bowel perforation secondary to prior surgery. On 1/6/2015, the patient underwent the 3rd surgery for bowel resection and drainage of abscess due to EAF formed through dehiscence of the prior anastomosis. Commercial NPWT kit V.A.C. (KCI, San Antonio, TX) was used by the physical therapist to manage the OA after the 2nd and 3rd surgery. The patient was discharged for home health on 1/16/2015 with a portable V.A.C system. Outcomes: The patient met the short term goals including development of healthy granulation tissues, shrinkage of the wound, and no occurrence of future complications. Discussion: Available evidences partially disapproved the caution of increasing EAF incidence by NPWT and supported advantages of NPWT in OA management, including decrease of mortality, increase of fascial closure, and healing of EAFs and enterocutaneous fistula (ECF) or transformation of EAFs to ECFs. With commercial NPWT system specifically designed for OA management, improvement of existing NPWT systems, and interdisciplinary cooperation, EAF, one of the severe complications of OA, could be controlled successfully