Management of a high-output postoperative enterocutaneous fistula with a vacuum sealing method and continuous enteral nutrition

A postoperative enterocutaneous fistula is one of the most complex medical problems. Its treatment may become longlasting, wearisome, and its outcome often is disappointing. Here, we describe the use of a novel device to trea t a 67-year-old patient with a postoperative, high-output enterocutaneous f istula. A semipermeable barrier was created over the fistula by vacuum pack ing a synthetic, hydrophobic polymer covered with a self-adherent surgical sheet. To set up the system, we constructed a vacuum chamber equipped with precision instruments that supplied subatmospheric pressures between 350 an d 450 mm Hg. The intestinal content was, thus, kept inside the lumen, resto ring bowel transit and physiology. The fistula output was immediately reduc ed from a median of 800 ml/day (range, 400-1,600 ml/day), to a median of 10 ml/day (range, 0-250 ml/day), which was readily collected by the apparatus . Oral feeding was reinitiated while both parenteral nutrition and octreoti de were withdrawn. No septic complications occurred, and the perifistular s kin stayed protected from irritating intestinal effluents. Both the fistula orifice and the wound defect fully healed after 50 days of treatment. We b elieve this method may serve as a useful tool to treat selected cases of hi gh-output enterocutaneous fistulas without the need for octreotide or paren teral nutrition.