Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014;5(3):164-8.
doi: 10.1016/j.ijscr.2014.01.006. Epub 2014 Jan 23.

Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report

Fahri Yetişir  1 , A Ebru Salman  2 , Ruslan Mamedov  3 , Mustafa Aksoy  2 , Abdussamet Yalcin  4 , Cüneyt Kayaalp  5
Affiliations

Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report

Fahri Yetişir et al. Int J Surg Case Rep. 2014.

Abstract

Introduction: To present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS.

Presentation of case: Twenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman's procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up.

Discussion: Management of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period.

Conclusion: Combination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula.

Keywords: Colorectal fistula; Dynamic closure; Negative pressure; Open abdomen.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
The view of open abdomen with colonic leakage in the operating room after admission to our center.
Fig. 2
Fig. 2
Application of standard abdomen negative pressure system (ABthera, KCI).
Fig. 3
Fig. 3
Three negative pressure systems were seen. 1. VAC was used on standard open abdomen. 2. VAC therapy system was used on gunshot lesions on left gluteus area. 3. Intrarectal negative pressure system was placed.
Fig. 4
Fig. 4
The tubing system was covered by part of silicone cover of the ABthera not to harm to the rectal mucosa during negative pressure application.
Fig. 5
Fig. 5
Rectal posh, fistula on it and retroperitoneal wound of two gunshots and their pathways are seen. Negative pressure effects of 3 VAC therapy systems on rectal wall and rectal fistula are showed. Illustration of neutralization of negative pressure effect of abdominal and wound side negative pressure systems on fistula at rectal posh by using intrarectal synchronized negative pressure system.
Fig. 6
Fig. 6
Entero-atmospheric fistula was taken under control and good granulation tissue was seen on 18 day.
Fig. 7
Fig. 7
Applied ABRA was seen.
Fig. 8
Fig. 8
Successfully closed abdominal wall was seen.
Fig. 9
Fig. 9
After anchor of ABRA was removed. There is no herniation or other complication.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. D’Hondt M., Devriendt D., Van Rooy F., Vansteenkiste F., D’Hoore A., Penninckx F. Treatment of small-bowel fistulae in the open abdomen with topical negative-pressure therapy. Am J Surg. 2011;202:20–24. - PubMed
    1. Verdam F.J., Dolmans D.E., Loos M.J., Raber M.H., de Wit R.J., Charbon J.A. Delayed primary closure of the septic open abdomen with a dynamic wound closure system. World J Surg. 2011;35:2348–2355. - PMC - PubMed
    1. Marinis A., Gkiokas G., Argyra E., Fragulidis G., Polymeneas G., Voros D. “Enteroatmospheric fistulae”—gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique. Scand J Surg. 2013;102(2):61–68. - PubMed
    1. Levy E., Frileux P., Cugnenc P.H., Parc R., Ollivier J.M., Honiger J. Exposed fistula of the small intestine, a complication of peritonitis or laparotomy. Apropos of 120 cases. Ann Chir. 1986;40:184–195. - PubMed
    1. Boele van Hensbroek P., Wind J., Dijkgraaf M.G., Busch O.R., Goslings J.C. Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen. World J Surg. 2009;33:199–207. - PMC - PubMed