A case : effective treatment of enteroatmospheric fistula after colon surgery

초록

Enteroatmospheric fistula (EAF) is a serious complication of patient with abdominal operative wound. EAF is difficult to control due to lack of a defined tract and overlay soft tissue. Bowel effluent through the fistula causes skin excoriation, cellulitis, and delayed wound healing. In addition, the presence of stool content in the wound increases bacterial burden and increases mortality rate with septic response. If not adequately managed, significant complications such as fluid and electrolyte imbalance, metabolic acidosis, malnutrition, sepsis and skin trouble, can occur in patients with EAF. A 54 year - old male patient underwent laparoscopic anterior resection due to sigmoid colon ca. On POD#1, the patient underwent colon segmental resection and loop ileostomy due to anastomotic leak. On POD#2, the patient underwent primary repair with jejunal microperforation. The patient’s condition deteriorated. And the medical team continued to use vasopressor during ICU care. Thereafter, necrosis developed at the fingers and toes and abdominal incision wound and wound dehiscence occurred. After removing the necrotic tissue of the abdominal wall, EAF occurred in the upper part of the open abdomen. The patient's EAF was high-output status. It was necessary to collect separately, the effluent of the upper fistula and that of the lower wound area. The purpose of this case review is to demonstrate the effect of negative pressure of wound therapy(NPWT) and pouching system for EAF management. We expected wound healing and achieve patient’s comfort with collecting upper fistula drainage separately from lower wound and protection of surrounding skin. To protect skin around the open abdomen, a crusting technique (skin barrier powder + alcohol-free sealant) was applied and hydrocolloid was applied along the edges. - Ring paste and pouch were applied to separate the lower wound area from the fistula. Suction was performed by inserting a catheter into the