Improvised vacuum assisted closure dressing for enterocutenous fistula, a case report

• Published in: International journal of surgery case reports Vol. 77; pp. 610 - 613
• Main Authors: Nyamuryekunge, Masawa K., Yango, Biswalo, Mwanga, Ally, Ali, Athar
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-01-2020; Elsevier
• Subjects: Africa; Case Report; Negative pressure wound therapy; Postoperative enterocutaneous fistula; Postoperative enterocutaneous fistula; Case report; Negative pressure wound therapy; Africa
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.11.049

•Enterocutaneous fistula is a postoperative complication is 75–80% of the cases that results in metabolic complications.•Management of this complication is difficult, necessitating delayed surgery with associated high morbidity and significant mortality.•Vacuum-assisted closure (VAC) dressing has been shown to decrease the healing time of chronic wounds and achieves a 64% spontaneous enterocutaneous fistula closure rate.•We improvised VAC dressing using simple materials for proximal enterocutaneous fistula.•Spontaneous closure was achieved on day 32.
Management of enterocutaneous fistula is challenging with high morbidities and mortalities despite the recent advances in surgical technique. The bad outcomes are a result of associated metabolic complications. Vacuum-assisted closure dressing for the management of enterocutaneous fistula is a relatively new technique with benefit as a bridge to definitive surgery or definitive management in achieving spontaneous closure at a shorter time. In the current report, we share our experience of improvising vacuum-assisted closure dressing for managing postoperative enterocutaneous fistula and achieving spontaneous closure
We describe a case of a 56-year-old male from Tanzanian with a postoperative discharge of intestinal contents from the wound. He was diagnosed to have a proximal enterocutaneous fistula. After sepsis control and achieving hemodynamic stability, the enterocutaneous fistula was managed with parenteral nutrition, proton pump inhibitors, anti-cathartics, and somatostatin analogs. Endoscopic therapies and fibrin sealants are other described nonoperative interventions for enterocutaneous fistula. The unavailability of these modalities limited us. Vacuum-assisted closure dressing was improvised using gauze pieces, feeding tube, and Op-site dressings at a pressure of −30 mmHg. We achieved spontaneous closure of the proximal enterocutaneous fistula in 32 days.
The time to closure was within the range of 12–90 described for conventional vacuum assisted closure dressing, and there were no complications. Close monitoring of improvised VAC dressings is required as the risks are unknown; however, given the known complications of conventional VAC dressing, a risk of hemorrhage and creation of entero-atmospheric fistula exists.
Improvised VAC dressing for ECF is potentially an acceptable option with promising outcomes in low-resource settings.