Management in Entero-Atmospheric Fistula

Abstract

Entero-atmospheric fistula (EAF) is the connecting tract between the intestine and the atmosphere without skin or subcutaneous coverage. This condition mainly occurs after an open abdomen in damage control surgery (DCS). The incidence of EAF following DCS is approximately 5-25%, with a mortality rate of 20-60%. The management phases consist of: The stabilization phase includes fluid resuscitation and electrolytes management, sepsis control, nutritional support, control of fistula drainage, and fistula/wound care. The investigation phase is to evaluate the anatomical and underlying pathology of EAF. The decision phase assesses the likelihood of spontaneous closure of EAF, which usually occurs 4-6 weeks after diagnosis. The definitive operation recommends following restored patient’s conditions within 6-12 months after diagnosis, including abdominal exploration, intraabdominal contamination, resection of perforated bowel and anastomosis, and tension-free abdominal wall reconstruction. Lastly, the rehabilitation phase normalizes the patient’s conditions.