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Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report

INTRODUCTION: We report the case of a successful management with combined aggressive surgery and negative pressure therapy, to treat a severely ill-septic patient, affected by multiple chronic enterocutaneous fistulas. PRESENTATION OF CASE: A 26-year-old female patient presented with multiple pelvic...

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Autores principales: Luglio, Gaetano, Amendola, Alfonso, Pagano, Gianluca, Tropeano, Francesca Paola, Errico, Chiara, Esposito, Enrica, Palomba, Giuseppe, Dinuzzi, Paola, De Simone, Giuseppe, De Palma, Giovanni Domenico
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390830/
https://www.ncbi.nlm.nih.gov/pubmed/32760581
http://dx.doi.org/10.1016/j.amsu.2020.06.037
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author Luglio, Gaetano
Amendola, Alfonso
Pagano, Gianluca
Tropeano, Francesca Paola
Errico, Chiara
Esposito, Enrica
Palomba, Giuseppe
Dinuzzi, Paola
De Simone, Giuseppe
De Palma, Giovanni Domenico
author_facet Luglio, Gaetano
Amendola, Alfonso
Pagano, Gianluca
Tropeano, Francesca Paola
Errico, Chiara
Esposito, Enrica
Palomba, Giuseppe
Dinuzzi, Paola
De Simone, Giuseppe
De Palma, Giovanni Domenico
author_sort Luglio, Gaetano
collection PubMed
description INTRODUCTION: We report the case of a successful management with combined aggressive surgery and negative pressure therapy, to treat a severely ill-septic patient, affected by multiple chronic enterocutaneous fistulas. PRESENTATION OF CASE: A 26-year-old female patient presented with multiple pelvic and intra-abdominal abscesses, enterocutaneous fistulas and central venous catheter-related bacteraemia in extremely poor general conditions. The patient underwent both an abdominal CT which showed multiple digestive loops stuck and apparently fistulised and an abdominal-pelvic MRI, confirming the CT findings, and demonstrating a third fistula involving the Pouch and responsible for a pelvic and retroperitoneal chronic abscess. Given the patient's septic condition, despite several attempts of conservative therapies, an aggressive surgical approach was adopted. After temporary abdominal wall closure, the patient underwent Vacuum Assisted Closure therapy in order to close the abdominal wall and drain the residual abscess. The patient was discharged at the 35th post-operative day in good general conditions. DISCUSSION: This case is about a complex, long-lasting clinical scenario, progressively leading a young woman to death despite several attempts of conservative therapy, sometimes allowed to treat enterocutaneous fistulas. The use of negative pressure therapy to manage open abdomen is still controversial. Patients affected by enterocutaneous fistulas are in need of adequate nutritional support due to their hypercatabolic state, secondary both to the fluid loss and the concomitant inflammatory status. CONCLUSION: When conservative management fails and the patient shows septic complications, a multidisciplinary aggressive approach, including surgery, negative-pressure therapy and hyperbaric oxygen therapy is required to treat this life-threatening condition.
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spelling pubmed-73908302020-08-04 Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report Luglio, Gaetano Amendola, Alfonso Pagano, Gianluca Tropeano, Francesca Paola Errico, Chiara Esposito, Enrica Palomba, Giuseppe Dinuzzi, Paola De Simone, Giuseppe De Palma, Giovanni Domenico Ann Med Surg (Lond) Case Report INTRODUCTION: We report the case of a successful management with combined aggressive surgery and negative pressure therapy, to treat a severely ill-septic patient, affected by multiple chronic enterocutaneous fistulas. PRESENTATION OF CASE: A 26-year-old female patient presented with multiple pelvic and intra-abdominal abscesses, enterocutaneous fistulas and central venous catheter-related bacteraemia in extremely poor general conditions. The patient underwent both an abdominal CT which showed multiple digestive loops stuck and apparently fistulised and an abdominal-pelvic MRI, confirming the CT findings, and demonstrating a third fistula involving the Pouch and responsible for a pelvic and retroperitoneal chronic abscess. Given the patient's septic condition, despite several attempts of conservative therapies, an aggressive surgical approach was adopted. After temporary abdominal wall closure, the patient underwent Vacuum Assisted Closure therapy in order to close the abdominal wall and drain the residual abscess. The patient was discharged at the 35th post-operative day in good general conditions. DISCUSSION: This case is about a complex, long-lasting clinical scenario, progressively leading a young woman to death despite several attempts of conservative therapy, sometimes allowed to treat enterocutaneous fistulas. The use of negative pressure therapy to manage open abdomen is still controversial. Patients affected by enterocutaneous fistulas are in need of adequate nutritional support due to their hypercatabolic state, secondary both to the fluid loss and the concomitant inflammatory status. CONCLUSION: When conservative management fails and the patient shows septic complications, a multidisciplinary aggressive approach, including surgery, negative-pressure therapy and hyperbaric oxygen therapy is required to treat this life-threatening condition. Elsevier 2020-07-15 /pmc/articles/PMC7390830/ /pubmed/32760581 http://dx.doi.org/10.1016/j.amsu.2020.06.037 Text en © 2020 The Authors. Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Luglio, Gaetano
Amendola, Alfonso
Pagano, Gianluca
Tropeano, Francesca Paola
Errico, Chiara
Esposito, Enrica
Palomba, Giuseppe
Dinuzzi, Paola
De Simone, Giuseppe
De Palma, Giovanni Domenico
Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report
title Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report
title_full Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report
title_fullStr Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report
title_full_unstemmed Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report
title_short Combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: A case report
title_sort combined surgical and negative pressure therapy to treat multiple enterocutaneous fistulas and abdominal abscesses: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390830/
https://www.ncbi.nlm.nih.gov/pubmed/32760581
http://dx.doi.org/10.1016/j.amsu.2020.06.037
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