Unusual clinical course, Diagnostic / therapeutic accidents, Unusual setting of medical care
Abdul-Wahed Nasir Meshikhes, Abdulrazzak Al-Hariri, Ali Ahmed Al-Zahir, Mamdouh Al-Nahawi
(General and Minimally Invasive Surgery Section, Department of Surgery, King Fahad Specialist Hospital, Dammam, Saudi Arabia)
Am J Case Rep 2013; 14:476-480
Background: Iatrogenic entero-atmospheric fistula is devastating and its management is extremely difficult because it is often associated with fluid and electrolyte disturbances, nutritional problems, and life-threatening sepsis.
Case Report: A 60-year-old woman underwent laparoscopic repair of a recurrent incisional hernia that was complicated by iatrogenic cecal injury necessitating a limited ileocecal resection and onlay prosthetic mesh repair of the hernia. Postoperatively, sloughing of the overlying skin led to mesh exposure. An attempted rotational flap coverage was complicated by small bowel injury, which was recognized and repaired. However, an entero-atmospheric fistula developed after the removal of contaminated mesh. The fistula was initially treated by vacuum-assisted closure dressing and later was converted to a ‘stoma’. Six months later, the small bowel segment bearing the fistula was excised and bowel continuity was restored.
Conclusions: In selected cases, the conversion of entero-atmospheric fistula to a ‘stoma’ allows the patient to be discharged home early and maintain good nutritional status while awaiting the definitive surgical intervention.
Keywords: stoma, Entero-atmospheric fistula, Colon Injury, incisional hernia, Laparoscopy