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Managing a complex prolapsed fistula

11 year old girl had surgery to remove a solid mass of indigestible material resulting in an ileostomy. The surgery wound developed a fistula resulting in the ileostomy not functioning and output functioning through the fistula.

By Marlaine Hendriks, Radboudumc Amalia kinderziekenhuis, Netherlands 

Patient Details

8th May 2015 

•11 Year old girl
•Abdominal pains / vomiting
•X ray revealed big foreign body in stomach: 5 x 5 x 11 cm
•Big bezoar seen on X ray (Solid mass of indigestible material that accumulates in stomach)
•Endoscopic removal on May 09th 2015 failed
•Surgical removal

Case details  

May 2015

•Wound: leaking exudate and starting dehiscence
•No skin irritation or red skin round wound
•No pressure pain
•Ileus
•Surgery: laparotomy found 5 isolated perforations in ileum, lot of hairballs
•Resulted in the patient needing an Ileostomy

Lateral dehiscence: leaking fluids
Medial wound leaks yellow fluid (pus)
Wound dehiscence: medial wound

•Faeces in medial wound: enterocutaneous fistula
•Surgery impossible: abdomen is not accesible
•Negative pressure wound therapy impossible: perforated intestine
•Wound therapy:
•Flushing wound therapy
•Absorbent wound dressings
•Ileostomy: no production
•Lots of faeces from enterocutaneous fistula

 

Treatment

May 2015

•Wound / stoma therapy:

•Isolating the fistula using Eakin Cohesive Seals and Cohesive Paste

•Alginate on the wound

•Using a 2-piece high output system

•Transfer from paediatric ward to Medical Center
•Wound / stoma therapy:
•1-Piece convex stoma system
•Eakin Cohesive Paste
•Eakin Cohesive Seals
•Alginate

 

9th July 2015

•Lots of leakages
•Wound contrahers well

Wound / Stoma policy, change every 48 hours:
•Remove stoma material with silicone wipes and remover spray
•Fill crevices and sides with Eakin Cohesive seals like a rooftop
•Eakin Cohesive Stomawrap on top
•1-piece stoma system
•Time for wound / stoma care: 1.5 hours!
- Due to high output
- Fear
- Pain

July 28th 2015

•Skin under control
•Stoma care every 48 hours
•Bathing
•Prolapse grew in size
•Little cranial wound

July 31st 2015

•Trying to get her out of the hospital with cooperation from specialized community child care nurses
•Stoma care


•2 half Eakin Cohesive Seals on the bottom

•3 half Eakin Cohesive Seals on the top
•Lateral 2 x ½ Eakin Cohesive Seals + ¼ Eakin Cohesive skin barriers
•Peristaltic

 


•1 Eakin Cohesive Stomawrap
•Stoma pouch
•Hydro strips around stoma pouch

11th August 2015

•Prolapse is growing
•Manipulation of stoma during care is very painful

 

10th September 2015

Complications

•Ulcera on prolapse is still growing
•Sometimes problems with blood flow
•Blue coloured prolapse

Patient leaves hospital 14th September

17th September 2015

•Growing prolapse
•“hanging” prolapse is painful → Support belt provides support

Outcome

30th September 2015

Continuity has been restored and the stoma has been closed.