Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report. (September 2020)

• Record Type: Journal Article
• Authors: Luglio, Gaetano; Amendola, Alfonso; Pagano, Gianluca; Tropeano, Francesca Paola; Errico, Chiara; Esposito, Enrica; Palomba, Giuseppe; Dinuzzi, Paola; De Simone, Giuseppe; De Palma, Giovanni Domenico
• Is Part Of: Annals of medicine and surgery. Volume 57(2020)
• Page Start: 123
• Page End: 126
• Publication Date: 2020-09
• Subjects: Negative pressure therapy -- Enterocutaneous fistulas -- VAC therapy -- abdominal wall closure; Surgery -- Periodicals; Medicine -- Periodicals; General Surgery -- Periodicals; Education, Medical -- Periodicals; Periodicals; 617
• DOI: 10.1016/j.amsu.2020.06.037
• Languages: English
• ISSNs: 2049-0801

Abstract

Abstract: Introduction: We report the case of a successful management with combined aggressive surgery and negative pressure therapy, to treat a severely ill-septic patient, affected by multiple chronic enterocutaneous fistulas. Presentation of case: A 26-year-old female patient presented with multiple pelvic and intra-abdominal abscesses, enterocutaneous fistulas and central venous catheter-related bacteraemia in extremely poor general conditions. The patient underwent both an abdominal CT which showed multiple digestive loops stuck and apparently fistulised and an abdominal-pelvic MRI, confirming the CT findings, and demonstrating a third fistula involving the Pouch and responsible for a pelvic and retroperitoneal chronic abscess. Given the patient's septic condition, despite several attempts of conservative therapies, an aggressive surgical approach was adopted. After temporary abdominal wall closure, the patient underwent Vacuum Assisted Closure therapy in order to close the abdominal wall and drain the residual abscess. The patient was discharged at the 35th post-operative day in good general conditions. Discussion: This case is about a complex, long-lasting clinical scenario, progressively leading a young woman to death despite several attempts of conservative therapy, sometimes allowed to treat enterocutaneous fistulas. The use of negative pressure therapy to manage open abdomen is still controversial. Patients affected by enterocutaneous fistulas are in need of adequate nutritional support due to their hypercatabolic state, secondary both to the fluid loss and the concomitant inflammatory status. Conclusion: When conservative management fails and the patient shows septic complications, a multidisciplinary aggressive approach, including surgery, negative-pressure therapy and hyperbaric oxygen therapy is required to treat this life-threatening condition. Highlights: Using negative pressure therapy to deal with difficult abdominal wall closure. Multidisciplinary team work is essential to optimize patients' surgical outcomes. Highly-demolitive surgery can benefit from the use of negative pressure therapy.