Abstract
Patient morbidity can result from technical errors, or it can simply be an unavoidable outcome related to a disease process and its surgical management. Some postoperative complications “come with the territory”—such as a possible wound infection or anastomotic leak in the setting of colectomy. On the other hand, enteroatmospheric fistula (EAF) is a complex and highly morbid complication, and one that is extremely painful and difficult for the patient, surgeon, nurse, and family alike. Occurrence of an EAF was a rare event as recently as 30 years ago and was often followed quickly by mortality due to sepsis, electrolyte imbalance, and malnutrition.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Duff JH, Moffat J. Abdominal sepsis managed by leaving abdomen open. Surgery. 1981;90(4):774–8.
Maetani S, Tobe T. Open peritoneal drainage as effective treatment of advanced peritonitis. Surgery. 1981;90(5):804–9.
Mughal MM, Bancewicz J, Irving MH. ‘Laparostomy’: a technique for management of intractable intra-abdominal sepsis. Br J Surg. 1986;73(4):253–9.
Hedderich GS, Wexler MJ, McLean AP, Meakins JL. The septic abdomen: open management with Marlex mesh with a zipper. Surgery. 1986;99(4):399–408.
Ivatury RR, Nallathambi M, Rohman M, Stahl WM. Open management of the posttraumatic septic abdomen. Am Surg. 1990;56(9):548–52.
Stone HH, Strom PR, Mullins RJ. Management of the major coagulopathy with onset during laparotomy. Ann Surg. 1983;197(5):532–5.
Burch JM, Ortiz VB, Richardson RJ, Martin RR, Mattox KL, Jordan GL. Abbreviated laparotomy and planned reoperation for critically injured patients. Ann Surg. 1992;215(5):476–84.
Barnes GE, Laine GA, Giam PY, Smith EE, Granger HJ. Cardiovascular responses to elevation of intra-abdominal hydrostatic pressure. Am J Physiol. 1985;248(2):R208–13.
Tremblay LN, Feliciano DV, Schmidt J, et al. Skin only or silo closure in the critically ill patient with an open abdomen. Am J Surg. 2001;182(6):670–5.
D’Hont M, Devriendt D, Van Rooy F, et al. Treatment of small-bowel fistulae in the open abdomen with topical negative-pressure therapy. Am J Surg. 2011;202(2):e20–4.
Pelz JOW, Doerfer J, Decker M, Dimmler A, Hohenberger W, Meyer T. Hyperthermic intraperitoneal chemoperfusion (HIPEC) decrease wound strength of colonic anastomosis in a rat model. Int J Colorectal Dis. 2007;22(8):941–7.
Boutros C, Somasundar P, Espat NJ. Early results on the use of biomaterials as adjuvant to abdominal wall closure following cytoreduction and hyperthermic intraperitoneal chemotherapy. World J Surg Oncol. 2010;72(8):1–7.
Polk TM, Schwab CW. Metabolic and nutritional support of the enterocutaneous fistula patient: a three-phase approach. World J Surg. 2012;36(3):524–33.
Schecter WP. Management of enterocutaneous fistulas. Surg Clin North Am. 2011;91(3):481–91.
Kritayakirana K, Maggio PM, Brundage S, Purtill MA, Staudenmayer K, Spain DA. Outcomes and complications of open abdomen technique for managing non-trauma patients. J Emerg Trauma Shock. 2010;3(2):118–22.
Bjorck M, D’Amours SK, Hamilton AE. Closure of the open abdomen. Am Surg. 2011;77 suppl 1:S58–61.
Fabian TC. Damage control in trauma: laparotomy wound management acute to chronic. Surg Clin North Am. 2007;87(1):73–93.
Miller RS, Morris Jr JA, Diaz Jr JJ, Herring MB, May AK. Complications after 344 damage-control open celiotomies. J Trauma. 2005;59(6):1365–71.
Schecter WP, Ivatury RR, Rotondo MF, Hirshberg A. Open abdomen after trauma and abdominal sepsis: a strategy for management. J Am Coll Surg. 2006;203(3):390–6.
Prichayudh S, Sriussadaporn S, Samorn P, et al. Management of open abdomen with an absorbable mesh closure. Surg Today. 2011;41(1):72–8.
Stevens P. Vacuum-assisted closure of laparostomy wounds: a critical review of the literature. Int Wound J. 2009;6(4):259–66.
Shaikh IA, Ballard-Wilson A, Yalamarthi S, Amin AI. Use of topical negative pressure in assisted abdominal closure does not lead to high incidence of enteric fistulae. Colorectal Dis. 2010;12(9):931–4.
Bee TK, Croce MA, Maginotti LJ, et al. Temporary abdominal closure techniques: a prospective randomized trial comparing polyglactin 910 mesh and vacuum-assisted closure. J Trauma. 2008;65:337–44.
Miller PR, Thompson JT, Faler BJ, Meredith JW, Chang MC. Late fascial closure in lieu of ventral hernia: the next step in open abdomen management. J Trauma. 2002;53(5):843–9.
Acosta S, Bjarnason T, Petersson U, et al. Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. Br J Surg. 2011;98(5):735–43.
Koss W, Ho HC, Yu M, et al. Preventing loss of domain: a management strategy for closure of the “open abdomen” during the initial hospitalization. J Surg Educ. 2009;66(2):89–95.
Vertrees A, Greer L, Pickett C, et al. Modern management of complex open abdominal wounds of war: a 5-year experience. J Am Coll Surg. 2008;207(6):801–9.
Kafie FE, Tessier DJ, Williams RA, et al. Serial abdominal closure technique (the “SAC” procedure): a novel method for delayed closure of the abdominal wall. Am Surg. 2003;69(2):102–5.
Blatnik J, Jin J, Rosen M. Abdominal hernia repair with bridging acellular dermal matrix- an expensive hernia sac. Am J Surg. 2008;196:47–50.
De Moya M, Dunham M, Inaba K, et al. Long-term outcome of acellular dermal matrix when used for large traumatic open abdomen. J Trauma. 2008;65:349–53.
Scott BG, Welsh FJ, Pham HQ, et al. Early aggressive closure of the open abdomen. J Trauma. 2006;60(1):17–22.
Schuster R, Singh J, Safadi BY, Wren SM. The use of acellular dermal matrix for contaminated abdominal wall defects: wound status predicts success. Am J Surg. 2006;192(5):594–7.
Kushimoto S, Yamamoto Y, Aiboshi J, et al. Usefulness of the bilateral anterior rectus abdominis sheath turnover flap method for early fascial closure in patients requiring open abdominal management. World J Surg. 2007;31(1):2–8.
Girard S, Sideman M, Spain DA. A novel approach to the problem of intestinal fistulization arising in patients managed with open peritoneal cavities. Am J Surg. 2002;184(2):166–7.
Becker HP, Willms A, Schwab R. Small bowel fistulas and the open abdomen. Scand J Surg. 2007;96(4):263–71.
Jamshidi R, Schecter WP. Biological dressings for the management of enteric fistulas in the open abdomen: a preliminary report. Arch Surg. 2007;142(8):793–6.
Collier B, Guillamondegui O, Cotton B, et al. Feeding the open abdomen. J Parenter Enteral Nutr. 2007;31(5):410–5.
Evenson AR, Fischer JE. Current management of enterocutaneous fistula. J Gastrointest Surg. 2006;10(3):455–64.
Harris C, Shannon R. An innovative enterostomal therapy nurse model of community wound care delivery: a retrospective cost-effectiveness analysis. J Wound Ostomy Continence Nurs. 2008;35(2):169–83.
Martinez JL, Luque-de-Leon E, Mier J, Blanco-Benevides R, Robledo F. Systematic management of postoperative enterocutaneous fistulas: factors related to outcomes. World J Surg. 2008;32(3):436–43.
Fischer PE, Fabian TC, Magnotti LJ, et al. A ten-year review of enterocutaneous fistulas after laparotomy for trauma. J Trauma. 2009;67(5):924–8.
Wright A, Wright M. Bedside management of an abdominal wound containing an enteroatmospheric fistula: a case report. Ostomy Wound Manage. 2011;57(1):28–32.
Ramsay PT, Mejia VA. Management of enteroatmospheric fistulae in the open abdomen. Am Surg. 2010;76(6):637–9.
Layton B, Dubose J, Nichols S, Connaughton J, Jones T, Pratt J. Pacifying the open abdomen with concomitant intestinal fistula: a novel approach. Am J Surg. 2010;199(4):e48–50.
Al-Khoury G, Kaufman D, Hirshberg A. Improved control of exposed fistula in the open abdomen. J Am Coll Surg. 2008;206(2):397–8.
Goverman J, Yelon JA, Platz JJ, Singson RC, Turcinovic M. The “Fistula-VAC”, a technique for management of enterocutaneous fistulae arising within the open abdomen: a report of 5 cases. J Trauma. 2006;60(2):428–31.
O’Brien B, Landis-Erdman J, Erwin-Toth P. Nursing management of multiple enterocutaneous fistulae located in the center of a large open abdominal wound: a case study. Ostomy Wound Manage. 1998;44(1):20–4.
Geoghegan J, Robert K. The Convatec Wound Manager: a new stoma appliance. Br J Clin Prac. 1990;44(12):750–1.
Subramanian MJ, Liscum KR, Hirshberg A. The floating stoma: a new technique for controlling exposed fistulae in abdominal trauma. J Trauma. 2002;53:386–8.
Dorta G. Role of octreotide and somatostatin in the treatment of intestinal fistulae. Digestion. 1999;60 suppl(2):53–6.
Battershill PE, Clissold SP. Octreotide: a review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential in conditions associated with excessive peptide secretion. Drugs. 1989;38(5):658–702.
Stevens P, Foulkes RE, Hartford-Benyon JS, Delicata RJ. Systematic review and meta-analysis of the role of somatostatin and its analogues in the treatment of enterocutaneous fistula. Eur J Gastroenterol Hepatol. 2011;23(10):912–22.
Draus Jr JM, Huss SA, Harty NJ, Cheadle WG, Larson GM. Enterocutaneous fistula: are treatments improving? Surgery. 2006;140(4):570–6.
Leandros E, Antonakis PT, Albanopoulos K, Dervenis C, Konstadoulakis MM. Somatostatin versus octreotide in the treatment of patients with gastrointestinal and pancreatic fistulas. Can J Gastroenterol. 2004;18(5):303–6.
Alivizatos V, Felekis D, Zorbalas A. Evaluation of the effectiveness of octreotide in the conservative treatment of postoperative enterocutaneous fistulas. Hepatogastroenterology. 2002;49(46):1010–2.
Hesse U, Ysebaert D, de Hemptinne B. Role of somatostatin-14 and its analogues in the management of gastrointestinal fistulae: clinical data. Gut. 2001;49 suppl 4:iv11–21.
Makhdoom ZA, Komar MJ, Still CD. Nutrition and enterocutaneous fistulas. J Clin Gastroenterol. 2000;31(3):195–204.
Alvarez C, McFadden DW, Reber HA. Complicated enterocutaneous fistulas: failure of octreotide to improve healing. World J Surg. 2000;24(5):533–7.
Paran H, Neufeld D, Kaplan O, Klausner J, Freund U. Octreotide for treatment of postoperative alimentary tract fistulas. World J Surg. 1995;19(3):430–3.
Sancho JJ, di Costanzo J, Nubiola P, et al. Randomized double-blind placebo-controlled trial of early octreotide in patients with postoperative enterocutaneous fistula. Br J Surg. 1995;82(5):638–41.
Kocak S, Bumin C, Karayalcin K, Alacayir I, Aribal D. Treatment of external biliary, pancreatic, and intestinal fistulas with a somatostatin analogue. Dig Dis. 1994;12(1):62–8.
Tang SJ, Nieto JM, Jensen DM, Ohning GV, Pisegna JR. The novel use of an intravenous proton pump inhibitor in a patient with short bowel syndrome. J Clin Gastroenterol. 2002;34(1):62–3.
Hickman Jr RL, Douglas SL. Impact of chronic critical illness on the psychological outcomes of family members. AACN Adv Crit Care. 2010;21(1):80–91.
Jernigan TW, Fabian TC, Croce MA, et al. Staged management of giant abdominal wall defects. Ann Surg. 2003;238:349–57.
Joels CS, Vanderveer AS, Newcomb WL, et al. Abdominal wall reconstruction after temporary abdominal closure: a ten-year review. Surg Innov. 2006;13:223–30.
Dionigi G, Dionigi R, Rovera F, et al. Treatment of high output entero-cutaneous fistulae associated with large abdominal wall defects: single center experience. Int J Surg. 2008;6:51–6.
Rodriguez ED, Bluebond-Langner R, Silverman RP, et al. Abdominal wall reconstruction following severe loss of domain: The R Adams Cowley Shock Trauma Center algorithm. Plast Reconstr Surg. 2007;120:669–80.
Ramirez OM, Ruas E, Dellon L. “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86:519–26.
Wind J, van Koperen PJ, Slors FM, Bemelman WA. Single-stage closure of enterocutaneous fistula and stomas in the presence of large abdominal wall defects using the components separation technique. Am J Surg. 2009;197:24–9.
Connolly PT, Teubner A, Lees NP, Anderson ID, Scott NA, Carlson GL. Outcome of reconstructive surgery for intestinal fistula in the open abdomen. Ann Surg. 2008;247:440–4.
De Vries Reilingh TS, van Goor H, Charbon JA, et al. Repair of giant midline abdominal wall hernias: “components separation technique” versus prosthetic repair. World J Surg. 2007;31:756–63.
Dragu A, Klein P, Unglaub F, et al. Tensiometry as a decision tool for abdominal wall reconstruction with component separation. World J Surg. 2009;33:1174–80.
Vargo D. Component separation in the management of the difficult abdominal wall. Am J Surg. 2004;188:633–7.
Shabatian H, Lee D, Abbas MA. Components separation: a solution to complex abdominal wall defects. Am Surg. 2008;74:912–6.
De Vries Reilingh TS, van Goor H, Rosman C, et al. “Components separation technique” for the repair of large abdominal wall hernias. J Am Coll Surg. 2003;196:32–7.
Howdieshell TR, Proctor CD, Sternberg E, Cué JI, Mondy JS, Hawkins ML. Temporary abdominal closure followed by definitive abdominal wall reconstruction of the open abdomen. Am J Surg. 2004;188:301–6.
Lowe JB, Lowe JB, Baty JD, Garza JR. Risks associated with “components separation” for closure of complex abdominal wall defects. Plast Reconstr Surg. 2003;111:1276–83.
Ewart CJ, Lankford AB, Gamboa MG. Successful closure of abdominal wall hernias using components separation technique. Ann Plast Surg. 2003;50:269–74.
Carbonell AM, Cobb WS, Chen SM. Posterior components separation during retromuscular hernia repair. Hernia. 2008;12:359–62.
Ennis LS, Young JS, Gampper TJ, Drake DB. The “open-book” variation of component separation for repair of massive midline abdominal wall hernia. Am Surg. 2003;69:733–43.
Tobias AM, Low DW. The use of subfascial vicryl mesh buttress to aid in the closure of massive ventral hernias following damage-control laparotomy. Plast Reconstr Surg. 2003;112:766–76.
Kingsnorth AN, Shahid MK, Valliattu AJ, Hadden RA, Porter CS. Open onlay mesh repair for major abdominal wall hernias with selective use of components separation and fibrin sealant. World J Surg. 2008;32:26–30.
Rosen MJ, Jin J, McGee MF, Williams C, Marks J, Ponsky JL. Laparoscopic component separation in the single-stage treatment of infected abdominal wall prosthetic removal. Hernia. 2007;11:435–40.
Stark B, Strigård K. Definitive reconstruction of full-thickness abdominal wall defects initially treated with skin grafting of exposed intestines. Hernia. 2007;11:533–6.
Hadad I, Small W, Dumanian GA. Repair of massive ventral hernias with the separation of parts technique: reversal of the ‘lost domain’. Am Surg. 2009;75:301–6.
Rosen MJ, Williams C, Jin J, et al. Laparoscopic versus open-component separation: a comparative analysis in a porcine model. Am J Surg. 2007;194:385–9.
Milburn ML, Shah PK, Friedman EB, et al. Laparoscopically assisted components separation technique for ventral incisional hernia repair. Hernia. 2007;11:157–61.
Maas SM, van Engeland M, Leeksma NG, Bleichrodt RP. A modification of the “components separation” technique for closure of abdominal wall defects in the presence of an enterostomy. J Am Coll Surg. 1999;189:138–40.
Liyanage SH, Purohit GS, Frye JNR, Giordano P. Anterior abdominal wall reconstruction with a Permacol implant. J Plast Reconstr Aesthet Surg. 2006;59:553–5.
Parker DM, Armstrong PJ, Frizzi JD, North JH. Porcine dermal collagen (Permacol) for abdominal wall reconstruction. Curr Surg. 2006;63:255–8.
Shaikh FM, Giri SK, Durrani S, Waldron D, Grace PA. Experience with porcine acellular dermal collagen implant in one-stage tension-free reconstruction of acute and chronic abdominal wall defects. World J Surg. 2007;31:1966–72.
Hsu PW, Salgado CJ, Kent K, et al. Evaluation of porcine dermal collagen (Permacol) used in abdominal wall reconstruction. J Plast Reconstr Aesthet Surg. 2009;62(11):1484–9.
Franklin ME, Gonzalez JJ, Glass JL. Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2-year follow-up. Hernia. 2004;8:186–9.
Ueno T, Pickett LC, de la Fuente S, Lawson DC, Pappas TN. Clinical application of porcine small intestinal submucosa in the management of infected or potentially contaminated abdominal defects. J Gastrointest Surg. 2004;8:109–12.
Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H. Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg. 2005;140:549–62.
Jin H, Rosen MJ, Blatnik J, et al. Use of acellular dermal matrix for complicated ventral hernia repair: does technique affect outcomes? J Am Coll Surg. 2007;205:654–60.
Espinosa-de-los-Monteros A, de la Torre JI, Marrero I, Andrades P, Davis MR, Vasconez LO. Utilization of human cadaveric acellular dermis for abdominal hernia reconstruction. Ann Plast Surg. 2007;58:264–7.
Patton JH, Berry S, Kralovich KA. Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions. Am J Surg. 2007;193:360–3.
Bellows CF, Albo D, Berger DH, Awad SS. Abdominal wall repair using human acellular dermis. Am J Surg. 2007;194:192–8.
Misra S, Raj PK, Tarr SM, Treat RC. Results of AlloDerm use in abdominal hernia repair. Hernia. 2008;12:247–50.
Bluebond-Langner R, Keifa ES, Mithani S, Bochicchio GV, Scalea T, Rodriguez ED. Recurrent abdominal laxity following interpositional human acellular dermal matrix. Ann Plast Surg. 2008;60:76–80.
Taner T, Cima RR, Larson WV, Dozios EJ, Pemberton JH, Wolff BG. Surgical treatment of complex enterocutaneous fistulas in IBD patients using human acellular dermal matrix. Inflamm Bowel Dis. 2009;15:1208–12.
Maurice SM, Skeete DA. Use of human acellular dermal matrix for abdominal wall reconstructions. Am J Surg. 2009;197:35–42.
Lin JH, Spoerke N, Deveney C, Martindale R. Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience. Am J Surg. 2008;197:599–603.
Pomahac B, Aflaki P. Use of a non-cross linked porcine dermal scaffold in abdominal wall reconstruction. Am J Surg. 2010;199(1):22–7.
Espinosa-de-los-Monteros A, de la Torre JI, Ahumada LA, Person DW, Rosenberg LZ, Vasconez LO. Reconstruction of the abdominal wall for incisional hernia repair. Am J Surg. 2006;191:173–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer Science+Business Media New York
About this chapter
Cite this chapter
Johnson, E.K. (2014). Enteroatmospheric Fistula. In: Steele, S.R., Maykel, J.A., Champagne, B.J., Orangio, G.R. (eds) Complexities in Colorectal Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-9022-7_8
Download citation
DOI: https://doi.org/10.1007/978-1-4614-9022-7_8
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-9021-0
Online ISBN: 978-1-4614-9022-7
eBook Packages: MedicineMedicine (R0)