Use of a silver dressing for management of an open abdominal wound complicated by an enterocutaneous fistula-from hospital to community.

BACKGROUND

Management of an open abdominal wound complicated by an enterocutaneous fistula poses multiple challenges. The enterocutaneous fistula we discuss opened directly into the abdominal wound, without forming a track through skin.

CASE

We discuss a patient who underwent a Hartmann's procedure for diverticulitis, followed by repeat laparotomies for washout. Due to the edematous bowel and ongoing sepsis, it was not possible to close the abdomen by primary closure. Negative pressure wound therapy (NPWT) has been used successfully in these circumstances. However, the position of an enterocutaneous fistula prevented application of NPWT, and a more conservative approach was used to reduce infection and enable wound closure by secondary intention.

CONCLUSION

Owing to the presence of an enterocutaneous fistula, we applied a silver-based dressing as an alternative to NPWT. The silver-based dressing was initially applied during the patient's hospital course and continued into the community, ultimately resulting in closure of the wound and fistula.