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. 2014;5(7):385-8.
doi: 10.1016/j.ijscr.2014.04.030. Epub 2014 May 9.

Management of fistula of ileal conduit in open abdomen by intra-condoit negative pressure system

Fahri Yetişir  1 , A Ebru Salman  2 , Muhittin Aygar  3 , Faik Yaylak  4 , Mustafa Aksoy  2 , Abdussamet Yalçin  3
Affiliations

Management of fistula of ileal conduit in open abdomen by intra-condoit negative pressure system

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

Abstract

Introduction: We aimed to present the management of a patient with fistula of ileal conduit in open abdomen by intra-condoid negative pressure in conjunction with VAC Therapy and dynamic wound closure system (ABRA).

Presentation of case: 65-Year old man with bladder cancer underwent radical cystectomy and ileal conduit operation. Fistula from uretero-ileostomy anastomosis and ileus occurred. The APACHE II score was 23, Mannheim peritoneal index score was 38 and Björck score was 3. The patient was referred to our clinic with ileus, open abdomen and fistula of ileal conduit. Patient was treated with intra-conduid negative pressure, abdominal VAC therapy and ABRA.

Discussion: Management of urine fistula like EAF in the OA may be extremely challenging. Especially three different treatment modalities of EAF are established in recent literature. They are isolation of the enteric effluent from OA, sealing of EAF with fibrin glue or skin flep and resection of intestine including EAF and re-anastomosis. None of these systems were convenient to our case, since urinary fistula was deeply situated in this patient with generalized peritonitis and ileus.

Conclusion: Application of intra-conduid negative pressure in conjunction with VAC therapy and ABRA is life saving strategies to manage open abdomen with fistula of ileal conduit.

Keywords: Dynamic closure; Entero atmospheric fistula; Ileal conduit; Negative pressure; Open abdomen.

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Figures

Fig. 1
Fig. 1
Severe urine peritonitis with edematous abdominal content and ileus. Dilated small intestine loops and large abdominal defect (29 cm × 25 cm) of open abdomen are shown.
Fig. 2
Fig. 2
Fistula from uretero-ileostomy anastomosis (arrow sign).
Fig. 3
Fig. 3
Standard abdomen negative pressure system was applied to the abdomen (ABthera, KCI) Silicone cover of VAC Therapy is seen.
Fig. 4
Fig. 4
Both applied standard abdominal VAC therapy system and intra-conduit negative pressure system are seen. Two negative pressure systems connected by Y connector are seen.
Fig. 5
Fig. 5
Well granulation tissue and ABRA system.
Fig. 6
Fig. 6
Modified application of ABRA.
Fig. 7
Fig. 7
Totally closed fascia and skin.
Fig. 8
Fig. 8
Schematic illustration of abdominal VAC therapy in conjunction with intra-conduit negative pressure systems.
See this image and copyright information in PMC

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