ABSTRACT
BACKGROUND: Isolation of the enteroatmospheric fistula (EAF) opening and prevention of contamination of the rest of the wound by effluent are important factors in the management of EAF. OBJECTIVE: The aim of this study is to describe an easily reproducible technique for effluent control in patients with EAF. MATERIALS AND METHODS: A retrospective analysis was conducted on all patients who underwent the present technique between 2013 and 2015. The surgical technique included condom-EAF anastomosis, fistula ring creation, negative pressure wound therapy (NPWT), and adaptation of an ostomy bag. RESULTS: A total of 7 patients with a Björck grade 4 abdomen were included. All fistulas were located in the small bowel with a median number of 2 EAFs (range, 2-3) in each patient, and the majority had moderate output volume. The mean number of NPWT changes was 10 (range, 5-18), the mean time of NPWT use was 75.7 days (range, 60-120 days), and the mean length of stay was 108.2 days (range, 103-160 days). The mean time of ostomy formation to restitution of bowel continuity was 14.3 months (range, 8-20 months). Open anterior component separation was employed in all cases for closure of the abdominal wall. No mortality, ventral herniation, or refistulization was registered in the study. The mean follow-up time was 8.5 months (range, 6-12 months). CONCLUSIONS: This is an easily reproducible and safe technique for effluent control in patients with Björk grade 4 abdomen with established EAF.
Subject(s)
Abdominal Cavity/surgery , Abdominal Wound Closure Techniques , Enterostomy/methods , Intestinal Fistula/surgery , Wound Healing/physiology , Adult , Aged , Colostomy/methods , Female , Humans , Intestinal Fistula/physiopathology , Male , Middle Aged , Negative-Pressure Wound Therapy , Retrospective Studies , Surgical Stomas/physiology , Suture Techniques , Treatment OutcomeABSTRACT
Resumen Introducción: La isquemia mesenterica se clasifica, según su etiología, en: embolismo arterial, trombosis arterial patologías no oclusivas y trombosis venosa mesenterica (TVM), que es la causa de laparotomía exploradora en 1 de cada 1000 pacientes con síndrome abdominal agudo. Es más común entre la quinta y la sexta décadas de la vida. Caso clínico: Masculino de 31 años de edad, afroamericano, sin antecedentes médicos. Con dolor abdominal generalizado de 72 horas de evolución. Con signos positivos de irritación peritoneal. La tomografia con defecto de llenado en vena mesenterica superior, vena esplénica y vena porta. Se realizó laparotomía de urgencia que requirió resección intestinal por necrosis de yeyuno. Se realizaron estudios hematológicos, oncológicos y autoinmunes sin hallazgos positivos. Discusión: Latrombosis venosa por lo regulares secundaria a síndromes de hipercoagulabilidad o neoplasias. La presentación clínica es inespecífica. En cuanto a los estudios de imagen que se pueden solicitar: ultrasonido, tomografia o resonancia magnética y angiografia percutánea con catéter. Las principales opciones terapéuticas para la isquemia mesenterica aguda son: el tratamiento endovascular, la revascularización quirúrgica, la anticoagulación y laparotomía exploradora en caso de complicaciones viscerales. Conclusión: Aunque es una patología poco frecuente, el médico debe estar familiarizado con su fisiopatologia, diagnóstico y las principales alternativas terapéuticas que hay para ella.
Abstract Background: Four common causes of mesenteric ischemia identified: arterial embolism, arterial thrombosis, non-occlusive pathologies and mesenteric venous thrombosis (MVT). MVT is an uncommon cause of acute abdominal pain and accounts for 1 in 1000 emergency surgical laparotomies for acute abdomen. Case Presentation: A 31 year old male, previously healthy, with 72 hour history of generalized abdominal pain on examination with signs of peritonitis. He underwent a computed tomographic (CT) scan of the abdomen and pelvis, which demonstrated thrombosis of the portal, splenic and superior mesenteric veins. A laparotomy was performed, we found jejunal necrosis and a bowel resection was required. Hematologic, oncologic and autoimmune studies were performed and all of them were negative. Discussion: Venous thrombosis is almost always secondary to other pathologies. The principle ones are: hypercoagulability and occult neoplasia. The clinical presentation is non-specific. To make a diagnosis one can use: a Doppler ultrasound, a CT angiography, a magnetic resonance and a catheter angiography. The available treatments for acute mesenteric ischemia are: endovascular procedures, bypass surgery, anticoagulation and a laparotomy to treat visceral complications. Conclusion: Even if this is an uncommon pathology, physicians need to be aware of pathophysiology, diagnosis and treatment of acute mesenteric ischemia.
