Management of an Enteroatmospheric Fistula

This case study examining the use of eakin Wound Pouches^™, eakin Cohesive^® paste and eakin Cohesive^® skin barriers in managing an open wound and enteroatmospheric fistula.

Submitted by: Lawrence Ikahu, Clinical Practice Consultant – Continence and Stoma Care, Aga Khan University Hospital, Nairobi, Kenya

Patient History

• A 72-year-old gentleman.

• Intestinal obstruction and a parastomal hernia.

• An interventional laparotomy was performed but the patient was left with an open abdomen.

• Later developed an enterocutaneous fistula.

• The enteroatmospheric fistula was being managed by negative pressure wound therapy (NPWT) with little success.

Care Management Plan

The new care management plan involved use of an eakin Wound Pouch^™ which facilitated the maintenance of moisture around the wound while allowing fistula output to drain, avoiding leakage. eakin Wound Pouches^™ were used for 3 weeks in hospital. The patient was discharged home with the eakin Wound Pouch^™ being changed every 2 days. A combination of eakin Cohesive^® skin barriers, eakin Wound Pouches^™ and eakin Cohesive^® paste were used to protect the surrounding skin. The eakin Wound Pouch^™ facilitated wound healing, ensured accurate measurement of output and did not hinder the gentleman’s mobility. Progress over the following month was impressive.

The wound reduced markedly in size from a 10 cm diameter to a 2 cm diameter, meaning wound closure was imminent. There were two options available for closure; either allow the small wound to close naturally or for the plastic surgeon to create a muscle flap.

Conclusion

• Fistula output could be monitored.

• Accurate fluid measurement.

• Patient discharged home.

• Patient able to be mobile.

• Odour Control.

• Home nurses only needed to attend every 2 days.