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Langenbecks Arch Surg. 2016 Feb;401(1):1-13. doi: 10.1007/s00423-015-1370-3. Epub 2016 Feb 11.

Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review.

Author information

1
Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, AUSL, Bologna, Italy. salo75@inwind.it.
2
Emergency Surgery Department, Maggiore Hospital of Parma, University of Parma, Parma, Italy.
3
Department of General Surgery, John Paul II Memorial Hospital, Belchatow, Poland.
4
General and Emergency Surgery Department, Terni Hospital, University of Perugia, Perugia, Italy.
5
Emergency Surgery and Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, AUSL, Bologna, Italy.

Abstract

BACKGROUND:

Entero-atmospheric fistula (EAF) is an enteric fistula occurring in the setting of an open abdomen, thus creating a communication between the GI tract and the external atmosphere. Management and nursing of patients suffering EAF carries several challenges, and prevention of EAF should be the first and best treatment option.

PURPOSE:

Here, we present a novel modified classification of EAF and review the current state of the art in its prevention and management including nutritional issues and feeding strategies. We also provide an overview on surgical management principles, highlighting several surgical techniques for dealing with EAF that have been reported in the literature throughout the years.

CONCLUSIONS:

The treatment strategy for EAF should be multidisciplinary and multifaceted. Surgical treatment is most often multistep and should be tailored to the single patient, based on the type and characteristics of the EAF, following its correct identification and classification. The specific experience of surgeons and nursing staff in the management of EAF could be enhanced, applying distinct simulation-based ex vivo training models.

KEYWORDS:

Abdominal sepsis; Acute care surgery; Critical care; EAF management algorithm; Entero-atmospheric fistula; Fistula prevention; Frozen abdomen; Negative pressure wound therapy (NPWT); Open abdomen complications; Review; Small-bowel fistula; Vacuum-assisted closure

PMID:
26867939
DOI:
10.1007/s00423-015-1370-3
[Indexed for MEDLINE]

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