Wright Aaron, Wright Monica
Davis Trauma Program, UC Davis Medical Center, Sacramento, California 95817, USA.
Ostomy Wound Manage. 2011 Jan;57(1):28-32.
Enteroatmospheric fistulae (EAF) - unnatural connections between the bowel and the outside environment - are a feared complication of major abdominal operations. EAF pose a life-threatening risk to patients already weakened by surgical insult by altering fluid and electrolyte balance and fostering malnutrition. The authors describe a method of wound management for a 64-year-old morbidly obese woman with a history of coronary artery disease, diabetes mellitus, and bipolar disorder who developed a large abdominal wound containing multiple high-output EAF after an incarcerated abdominal hernia repair, wound infection, and subsequent laparotomy and lysis of adhesions followed by graft placement and negative pressure wound therapy. The volume, consistency, and location of the EAF caused commercial negative pressure devices to fail and simple gauze dressings were ineffective in maintaining a clean wound base and containing odor. Effluent collection and wound healing was achieved utilizing a modified method of EAF management that included two connecting rubberized catheter drains and continuous wound irrigation with wall suction and cotton gauze for debridement. Surgical EAF closure was successful after 6 months of care. This method provided a satisfactory balance between the diagnosis of EAF and the readiness to meet the physiologic demands of definitive surgical treatment.
肠-腹壁瘘（EAF）——肠道与外界环境之间的异常连接——是腹部大手术令人担忧的并发症。EAF通过改变体液和电解质平衡以及加剧营养不良，对因手术创伤而已经虚弱的患者构成危及生命的风险。作者描述了一种针对一名64岁病态肥胖女性的伤口处理方法，该女性有冠状动脉疾病、糖尿病和双相情感障碍病史，在嵌顿性腹疝修补、伤口感染、随后的剖腹手术和粘连松解，以及植皮和负压伤口治疗后，出现了一个包含多个高流量EAF的大腹部伤口。EAF的量、黏稠度和位置导致商用负压装置失效，简单的纱布敷料在保持伤口基底清洁和控制气味方面无效。通过一种改良的EAF处理方法实现了引流液收集和伤口愈合，该方法包括两个相连的橡胶导管引流管，以及通过墙壁吸引和棉纱布进行持续伤口冲洗以清创。经过6个月的护理，手术成功闭合了EAF。这种方法在EAF的诊断与满足确定性手术治疗的生理需求的准备程度之间提供了令人满意的平衡。
