How to isolate a high output enteroatmospheric fistula in the open abdomen with negative pressure therapy: an institution's step by step guide to the VAC donut.

There is multiple evidence to suggest that isolation techniques of high output enteroatmospheric fistulas (EAF) in open abdomens can be advantageous in controlling fistula effluent while allowing time for abdominal wall to granulate. The large loss of proteins, electrolytes and fluid, and the distressing nature of the open abdomen for both patients and doctors, make managing these EAFs a clinical challenge. We present our experience with a high output mucosal protruding EAF and the creation of a 'VAC donut' allowing a successful diversion of the enteric content whilst promoting granulation of the tissue bed.

Non-marginal jejunal ulcer perforation following Roux-en-Y gastric bypass.

We present a rare case of a jejunal ulcer perforation in the alimentary limb ~15 cm distal to the gastro-jejunal anastomosis on the background of a previous Roux-en-Y gastric bypass (RYGB) 4 months prior to presentation. Marginal ulcer is the most common cause of jejunal perforation following RYGB. However, this is usually confined to the first few centimetres, and the incidence is highest within the first month following surgery. Other risk factors include smoking and non-steroidal anti-inflammatory drug use, Helicobacter pylori infection, trauma, foreign body ingestion, Crohn's disease, typhoid, tuberculosis and malignancy. This case does not possess any of these risk factors and thus represents a unique presentation. Not all jejunal ulcers will present with classical risks factors but still will need to be excluded, given their life-threatening nature. Also, the whole alimentary limb can be susceptible to ulceration; therefore, a thorough investigation of this limb is important to exclude perforation.

Breaking the general practice-hospital divide: Engaging primary care practitioners in multidisciplinary cancer care.

AIMS: To integrate primary care into multidisciplinary cancer meetings and improve communication between hospital- and community-based care providers. METHODS: A 12-week pilot study was conducted at Western Health, implementing a model of care, where two general practitioners (GPs) were recruited from the local community to attend weekly breast and lung multidisciplinary meetings in a liaison role as a primary care representative (PCR). Community GPs and hospital specialists were surveyed at the end of the study to assess the impact of this model of care. RESULTS: All stakeholders agreed that two-way communication between hospital- and community-based care was improved. The role of the PCR enabled better engagement of GPs in cancer care, allowing them to manage their patients with more confidence. Patient information contributed by GPs provided a wider context for hospital specialist treatment planning and decision making. CONCLUSION: This project has demonstrated an effective model to integrate primary care practitioners in multidisciplinary cancer care, as it enables timely and relevant two-way communication between the community and hospital care.