title: Intrarectal negative pressure system in the management of open abdomen with colorectal fistula: A case report.
abstract: BACKGROUND
  To present the management of open abdomen with colorectal fistula by application of intrarectal negative pressure system (NPS) in addition to abdominal NPS.
  
  
  METHODS
  Twenty-year old man had a history of injuries by a close-range gunshot to the abdomen eight days ago and he had been treated by bowel repairs, resections, jejunal anastomosis and Hartman's procedure. He was referred to our center after deterioration, evisceration with open abdomen and enteric fistula in septic shock. There were edematous, fibrinous bowels and large multiple fistulas from the edematous rectal stump. APACHE II, Mannheim Peritoneal Index and Björck scores were 18, 33 and 3, respectively (expected mortality 100%). After intensive care for 5 days, he was treated by abdominal and intrarectal NPS. NPS repeated for 5 times and the fistula was recovered on day 18 completely. Fascial closure was facilitated with a dynamic abdominal closure system (ABRA) and he was discharged on day 33 uneventfully. There was no herniation and any other problem after 12 months follow-up.
  
  
  CONCLUSIONS
  Management of fistula in OA can be extremely challenging. Floating stoma, fistula VAC, nipple VAC, ring and silo VAC, fistula intubation systems are used for isolation of the enteric effluent from OA. Several biologic dressings such as acellular dermal matrix, pedicled flaps have been used to seal the fistula opening with various success. Resection of the involved enteric loop and a new anastomosis of the intestine is very hard and rarely possible. In all of these reports, usually patients are left to heal with a giant hernia. In contrast to this, there is no hernia in our case during one year follow up period.
  
  
  CONCLUSIONS
  Combination of intra and extra luminal negative pressure systems and ABRA is a safe and successful method to manage open abdomen with colorectal fistula.
authors.affiliation: Atatürk Research and Training Hospital, General Surgery Department, Ankara, Turkey; Inonu University, Liver Transplantation Institute, Malatya, Turkey. Electronic address: drfahriyetisir@hotmail.com.
authors.forename: Fahri
authors.initials: F
authors.lastname: Yetişir
authors.affiliation: Atatürk Research and Training Hospital, Anesthesiology and Reanimation Department, Turkey.
authors.forename: A Ebru
authors.initials: AE
authors.lastname: Salman
authors.affiliation: Inonu University, Liver Transplantation Institute, Malatya, Turkey; Azerbaijan Medical University, Baku, Azerbaijan.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Mamedov
authors.affiliation: Atatürk Research and Training Hospital, Anesthesiology and Reanimation Department, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Aksoy
authors.affiliation: Atatürk Research and Training Hospital, General Surgery Department, Ankara, Turkey.
authors.forename: Abdussamet
authors.initials: A
authors.lastname: Yalcin
authors.affiliation: Inonu University, Liver Transplantation Institute, Malatya, Turkey.
authors.forename: Cüneyt
authors.initials: C
authors.lastname: Kayaalp
keywords: Colorectal fistula; Dynamic closure; Negative pressure; Open abdomen