Cho Jinbeom, Sung Kiyoung, Lee Dosang
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea.
World J Clin Cases. 2022 Jul 16;10(20):6954-6959. doi: 10.12998/wjcc.v10.i20.6954.
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.
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.
Control of the enteric effluent are key elements in achieving favorable clinical conditions which should precede definite surgery for EAFs.
肠腹壁瘘（EAF）是开腹术后可能出现的一种灾难性并发症。EAF会导致严重的体液丢失、高分解代谢和伤口并发症，从而导致不良的临床结局。
一名72岁女性患者接受了腹疝修补术。术后5天，她出现严重腹痛并伴有感染性休克。剖腹探查发现广泛的肠粘连和严重的腹腔内污染。由于患者血流动力学不稳定，需要进行挽救性手术而非确定性手术，并在腹腔内插入了三根手术开放引流管。术后发生了EAF，尽管使用了负压封闭引流敷料和内镜支架置入术，但几乎无法隔离并减少瘘口排出量。最后，我们将两根血管移植物吻合到每个EAF的开口处，以恢复肠道连续性。插入的血管移植物显示出可接受的通畅性，患者可以通过要素肠内喂养获得最佳营养支持。在移植物植入76天后，她接受了EAF切除术。
控制肠液流出是实现良好临床状况的关键因素，这应先于EAF的确定性手术。
