A novel approach to the problem of intestinal fistulization arising in patients managed with open peritoneal cavities.
Open management of the peritoneal cavity is an efficacious technique for controlling fulminant intraabdominal sepsis. A significant proportion of these patients develop intestinal fistulae for which there are few good treatment options. We propose a novel technique for preventing and potentially treating intestinal fistulas that involves patching intestinal deserosalizations and fistulas with acellular dermal matrix (Alloderm) and fibrin glue. We report our experience with this technique in 2 patients who developed small bowel deserosalizations, neither of whom went on to develop fistulas. We additionally describe 1 patient who developed an intestinal fistula for whom we were able to affect closure with this technique. We propose that our method is a useful temporizing measure to prevent fistulae formation. Furthermore, we believe this technique may be a useful option for treating intestinal fistulae arising in patients managed with open abdominal wounds.
Girard
Stephen
S
Department of Surgery, University of Louisville School of Medicine, KY 40292, USA.
Sideman
Matthew
M
Spain
David A
DA
D003094:Collagen / Q000494:pharmacology*; D015718:Fibrin Tissue Adhesive / Q000494:pharmacology; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology / Q000601:surgery*; D007421:Intestine, Small / Q000503:physiopathology; D010529:Peritoneal Cavity / Q000503:physiopathology*; D011379:Prognosis; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications / Q000175:diagnosis; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing
C440568:Alloderm; D015718:Fibrin Tissue Adhesive; D003094:Collagen