AB064. SOH23ABS_161. Video presentation showing the use of a negative pressure wound therapy with isolation device for management of a complex ventral abdominal wall wound with an enteroatmospheric fistula formation

Background: Enteroatmospheric fistulas (EAFs) are a difficult to manage subset of enterocutaneous fistulas. EAFs are a serious complication of laparotomy wounds and can be difficult to manage, often associated with long-term disability and morbidity.

Methods: We present the case of a 70-year-old female patient who underwent an elective re-siting of an end-colostomy and abdominal wall reconstruction, after initially having an emergent Hartmann’s procedure for perforated diverticulitis. A retro-rectus mesh was implanted and a previous stoma site was relocated to the right upper quadrant, the patient recovered well and was discharged home. She then represented approximately 1 year later with septic shock secondary to a strangulated parastomal hernia. The patient was returned to surgery for resection of the ischaemic colon and resiting of the end colostomy to the lower left quadrant. The patient responded well after a number of weeks in intensive care unit (ICU), however there was persistent difficulty in managing the resultant EAF and abdominal wall wound.

Results: We present a video with a series of photos demonstrating the use of a negative pressure wound therapy (NPWT) with isolation device to manage the abdominal wall wound from the EAF. The use of the NPWT with isolation device has resulted in rapid healing, with significant reduction in the surface area of the wound while continuing to allow drainage of the EAF.

Conclusions: We believe the use of NPWT with isolation devices to be an invaluable tool for the management of complex wounds with EAFs.

Keywords: Enteroatmospheric fistula (EAF); negative pressure wound therapy (NPWT); abdominal wall wound; enterocutaneous fistula; dehiscence