Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2022; 10(20): 6954-6959
Published online Jul 16, 2022. doi: 10.12998/wjcc.v10.i20.6954
Management of the enteroatmospheric fistula: A case report
Jinbeom Cho, Kiyoung Sung, Dosang Lee
Jinbeom Cho, Kiyoung Sung, Dosang Lee, Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Author contributions: Cho J and Sung K participated in treatment and prepared manuscript and performed the literature search; Lee D participated in manuscript revision and final review; and all authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dosang Lee, MD, PhD, Professor, Department of Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, South Korea. surgeryds@gmail.com
Received: September 13, 2021
Peer-review started: September 13, 2021
First decision: November 22, 2021
Revised: December 4, 2021
Accepted: May 26, 2022
Article in press: May 26, 2022
Published online: July 16, 2022
Processing time: 294 Days and 23.1 Hours
Abstract
BACKGROUND

Enteroatmospheric fistula (EAF) is a catastrophic complication that can occur after open abdomen. EAFs cause severe body fluid loss, hypercatabolism, and wound complications, leading to adverse clinical outcomes.

CASE SUMMARY

A 72-year-old female patient underwent ventral hernia repair. Five days after the surgery, she exhibited severe abdominal pain with septic shock. Exploratory laparotomy revealed extensive intestinal adhesions and severe intraperitoneal contamination. Since the patient was hemodynamically unstable, a salvage operation rather than definite surgery was needed, and three surgical open drains were inserted into the peritoneal cavity. Postoperative EAFs developed, and it was almost impossible to isolate and reduce the fistula output despite the use of vacuum-assisted closure dressings and endoscopic stent insertion. Finally, we anastomosed two vascular grafts to the openings of each EAF to restore enteric continuity. The inserted vascular grafts showed acceptable patency, and the patient could receive optimal nutritional support with elemental enteral feeding. She underwent EAF resection 76 d after graft implantation.

CONCLUSION

Control of the enteric effluent are key elements in achieving favorable clinical conditions which should precede definite surgery for EAFs.

Keywords: Enterocutaneous fistula; Enteroatmospheric fistula; Ventral hernia; Complication; Sepsis; Case report

Core Tip: Enteroatmospheric fistula (EAF) is a catastrophic complication that can occur after open abdomen. EAFs cause severe body fluid loss, hypercatabolism, and wound complications, leading to adverse clinical outcomes. Small and low-output EAFs might be managed by “reduction and isolation” strategies with vacuum assisted closed dressings to achieve spontaneous healing, while large and high-output EAFs should be resected when the patients are clinically stable. Infection control and management of the enteric effluent are key elements in achieving favorable clinical conditions which should precede definite surgery for EAFs.