Management of the enteroatmospheric fistula: A case report

BACKGROUND Enteroatmospheric fistula (EAF) is a catastrophic complication that can occur after open abdomen. EAFs cause severe body fluid loss, hypercatabolism, and wound complications, leading to adverse clinical outcomes. CASE SUMMARY A 72-year-old female patient underwent ventral hernia repair. Five days after the surgery, she exhibited severe abdominal pain with septic shock. Exploratory laparotomy revealed extensive intestinal adhesions and severe intraperitoneal contamination. Since the patient was hemodynamically unstable, a salvage operation rather than definite surgery was needed, and three surgical open drains were inserted into the peritoneal cavity. Postoperative EAFs developed, and it was almost impossible to isolate and reduce the fistula output despite the use of vacuum-assisted closure dressings and endoscopic stent insertion. Finally, we anastomosed two vascular grafts to the openings of each EAF to restore enteric continuity. The inserted vascular grafts showed acceptable patency, and the patient could receive optimal nutritional support with elemental enteral feeding. She underwent EAF resection 76 d after graft implantation. CONCLUSION Control of the enteric effluent are key elements in achieving favorable clinical conditions which should precede definite surgery for EAFs.