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Management of a complex open abdominal wound

Jeanette Fingren RN ETN, Colorectal unit Sahlgrenska University Hospital/Östra, Göteborg, Sweden

Background
A fistula is an abnormal connection between an organ, vessel or intestine and another organ, vessel or intestine, or the skin. Fistulas can be thought of as tubes connecting internal tubular structures, such as arteries, veins or intestine, to one another or to the skin.

Fistulas are usually the result of trauma or surgery, but can also result from infection or inflammation.

Introduction
High-output enterocutaneous fistulas involving an open abdominal wound are a difficult management problem and put a strain on the patient and his family.

Aim
The aim of this case study was to report a method of effectively pouching an open abdominal wound with a small bowel fistula.
 
Methods
A 65 year old gentleman was operated with abdominoperineal rectal excision and a sigmoideostomy. A huge parastomal hernia developing subsequently was repaired and the sigmoideostomy moved to the right side of the abdomen. Intestinal obstruction postoperatively required laparotomy showing small bowel obstruction with a gangrenous segment. Small bowel resection was done and a transverse colostomy constructed.

Ten days later total wound dehiscence and evisceration (bowel contents protruding through the abdominal wall). Abdomen had to be left open collecting small bowel contents in a specially designed fistula bag
Results
In this case study it was shown that the application of a wound management system as the Eakin Fistula & Wound Pouch was the most cost effective, clinically efficient and effective wound management option. It has been proven time and time again that with large complex wounds and fistulas, you can achieve healing with no adverse effects, such as secondary infection. They can be managed as I will describe and show with pictures in this case study.

Fig 3Fig 3Fig 2Fig 2Fig 1Fig 1
 
 
 
 
 
Fig 1-3: Change the fistula and wound pouch every 3rd day. Cared for in hospital during 3 month.

 
Fig 5Fig 5Fig 4Fig 4
 
Fig 4-5: The patient is at home and the fistula and wound pouch is changed every 2nd-3rd day by the home care team.
 
 
 
 
 
Fig 6Fig 6Fig 6: After 10 months a transverse colostomy was constructed on the left side of the man's abdomen and then abdomen was closed without any complications.

 
Conclusion
Besides the wellbeing and comfort of the patient, cost is a huge aspect of caring for a complex wound. Using Eakin Fistula & Wound management pouch was found to be the best wound management system to manage both for the patient and the staff.
 
References
Watret L & White R. Surgical wound management: the role of dressings. Nursing standard 2001,15(44):59-69.
Wound exudate and the role of dressings. A consensus document. Int Wound J. 2008 Mar;5 Suppl 1:iii-12.