Abstract
Enteroatmospheric fistula (EAF) is defined as an enteric leak into an open abdomen. Its occurrence is one of the most feared complications for the acute care surgeon. The incidence of EAF is currently increasing due to a more liberal use of damage control surgery. Daily management is burdened by high complication and mortality rates and relevant costs for the national health system. Early identification and referral to specialized centers are critical aspects for better outcomes. The approach should be based on a step-up process in which surgery is the light at the end of the tunnel. The first steps should focus on clinical assessment and optimization of metabolic, septic and anatomical aspects. The intermediate step before definitive surgery is demanding in terms of time and resources and relies on different surgical techniques for fistula management. Definitive surgery can be planned only when timing and clinical condition are respected. Acute care surgeons must be aware that the clinical pathway of EAF patients is not always straightforward. This chapter aims to overview the critical aspects of classification and management of EAF and is designed to be a daily practice guide, with clinical and surgical insights relevant not only to experienced acute care surgeons.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Björck M, Bruhin A, Cheatham M, et al. Classification – important step to improve management of patients with an open abdomen. World J Surg. 2009;33(6):1154–7.
Dubose JJ, Lundy JB. Enterocutaneous fistulas in the setting of trauma and critical illness. Clin Colon Rectal Surg. 2010;23(3):182–9.
Majercik S, Kinikini M, White T. Enteroatmospheric fistula: from soup to nuts. Nutr Clin Pract. 2012;27(4):507–12.
Verhaalen A, Watkins B, Brasel K. Techniques and cost effectiveness of enteroatmospheric fistula isolation. Wounds. 2010;22(8):212–7.
Di Saverio S, Tarasconi A, Walczak DA, et al. Classification, prevention and management of entero-atmospheric fistula: a state-of-the-art review. Langenbeck’s Arch Surg. 2016;401(1):1–13.
Coccolini F, Ceresoli M, Kluger Y, et al. Open abdomen and entero-atmospheric fistulae: an interim analysis from the International Register of Open Abdomen (IROA). Injury. 2019;50(1):160–6.
Bradley MJ, Dubose JJ, Scalea TM, et al. Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST Open Abdomen registry. JAMA Surg. 2013;148(10):947–54.
Bruhin A, Ferreira F, Chariker M, et al. Systematic review and evidence based recommendations for the use of negative pressure wound therapy in the open abdomen. Int J Surg. 2014;12(10):1105–14.
Richter S, Dold S, Doberauer JP, et al. Negative pressure wound therapy for the treatment of the open abdomen and incidence of enteral fistulas: a retrospective bicentre analysis. Gastroenterol Res Pract. 2013;2013:730829. https://doi.org/10.1155/2013/730829.
Miller RS, Morris JA Jr, Diaz JJ Jr, et al. Complications after 344 damage-control open celiotomies. J Trauma. 2005;59(6):1365–71; discussion 1371–4.
Giudicelli G, Rossetti A, Scarpa C, et al. Prognostic factors for enteroatmospheric fistula in open abdomen treated with negative pressure wound therapy: a multicentre experience. J Gastrointest Surg. 2017;21(8):1328–34.
Mintziras I, Miligkos M, Bartsch DK. High risk of fistula formation in vacuum-assisted closure therapy in patients with open abdomen due to secondary peritonitis – a retrospective analysis. Langenbeck’s Arch Surg. 2016;401(5):619–25.
Sobotka L, editor. Basics in clinical nutrition. 4th ed. Prague: Galén; 2007.
Preiser JC, Schneider SM. ESPEN disease-specific guideline framework. Clin Nutr. 2011;30(5):549–52.
Klek S, Forbes A, Gabe S, et al. Management of acute intestinal failure: a position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group. Clin Nutr. 2016;35(6):1209–18.
Levy MM, Evans LE, Rhodes A. The surviving sepsis campaign bundle: 2018 update. Intensive Care Med. 2018;44(6):925–8.
Tonolini M, Magistrelli P. Enterocutaneous fistulas: a primer for radiologists with emphasis on CT and MRI. Insights Imaging. 2017;8(6):537–48.
Leppäniemi A, Kimball EJ, De Laet I, et al. Management of abdominal sepsis – a paradigm shift? Anaesthesiol Intensive Ther. 2015;47(4):400–8.
Solomkin JS, Mazuski JE, Bradley JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(2):133–64.
Adnan S, Paterson DL, Lipman J, et al. Pharmacokinetics of beta-lactam antibiotics in patients with intra-abdominal disease: a structured review. Surg Infect. 2012;13(1):9–17.
De Waele JJ. Early source control in sepsis. Langenbeck’s Arch Surg. 2010;395(5):489–94.
Weimann A, Braga M, Carli F, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50.
Chiara O, Cimbanassi S. Atlas of open abdomen in trauma. How to do it. Minerva Medica: Turin; 2017.
Marinis A, Gkiokas G, Argyra E, et al. “Enteroatmospheric fistulae” – gastrointestinal openings in the open abdomen: a review and recent proposal of a surgical technique. Scand J Surg. 2013;102(2):61–8.
Martinez JL, Luque-de-León E, Souza-Gallardo LM, et al. Results after definitive surgical treatment in patients with enteroatmospheric fistula. Am Surg. 2018;84(1):28–35.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG
About this chapter
Cite this chapter
Bini, R., Cioffi, S.P.B., Del Prete, L. (2022). Enteroatmospheric Fistula: A Challenge of Acute Care Surgery. In: Chiara, O. (eds) Trauma Centers and Acute Care Surgery. Updates in Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-73155-7_12
Download citation
DOI: https://doi.org/10.1007/978-3-030-73155-7_12
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-73154-0
Online ISBN: 978-3-030-73155-7
eBook Packages: MedicineMedicine (R0)