Enteric Fistula: The Wound Ostomy Continence Nurse`s Role in Containing Fistula Effluent and Promoting Wound Healing

Background: Approximately 75-85% of enteric fistulas occur as complications following abdominal surgery (deVries, F. E. E., Atema, J. J. , van Ruler, O., Vaizey, C. J., Serlie, M. J., Boermeester, M. A., 2017). Managing enteric fistulas presents challenges and requires a multidisciplinary approach to manage sepsis, nutrition, electrolyte repletion, containment of fistula effluent and wound care.

This case series discusses three patients with enteric fistulas and the wound ostomy continence (WOC) nurse's role in containing fistula effluent and promoting wound healing.

Case 1: A 62 year old male with a history of perforated diverticulitis and a Hartmann's procedure, admitted for a Hartmann's reversal. Surgery was complicated by an anastomotic leak requiring an exploratory laparotomy, washout and loop ileostomy. The abdominal incision dehisced followed by the development of enterocutaneous fistulas. A wound management system was used to contain the fistula effluent. Wound care was provided for the abdominal wound.

Case 2: A 63 year old female with a history of a laparotomy, hysterectomy, myomectomy, resection of fibroids and lysis of adhesions. Surgery was complicated by a sigmoid perforation, septic shock and an abdominal wound with a stomatized fistula. Fistula and wound management involved isolation of the fistula with ostomy rings and negative pressure wound therapy (NPWT).

Case 3: A 65 year old female with a history of a gastric bypass and status post a panniculectomy. Postoperatively the patient became septic, requiring abdominal washouts and resulted in an abdominal wound with a stomatized fistula. Fistula and wound management involved a fistula isolation product to isolate the fistula and NPWT.

Conclusion: Enteric fistulas require a multidisciplinary approach to patient care. WOC nurses provide invaluable strategies to contain fistula effluent and promote wound healing.