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: Report
• Language: English
• Published: 01-01-2020
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2020.11.049

INTRODUCTIONManagement 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 PRESENTATION OF CASE: 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. DISCUSSIONThe 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. CONCLUSIONImprovised VAC dressing for ECF is potentially an acceptable option with promising outcomes in low-resource settings.