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We have been seeing this patient off and on for at least 3 years, she has a non-surgical fistula, mess is seen. She has been seen at Mayo and here in Newton and no surgical option has been given. At this time she has and Eakins pouch however, her skin is really starting to have issues. The pouches are only lasting about 24 hours do to the erosion from the bowel contents. We are thinking about a applying for a wound vac to control the liquid. Possible a low suction to maintain fluid and increase quality of life. Any thoughts would be helpful.
Elaine Horibe Song
Hi Kim, Cathy and I discussed, here are some thoughts:
Definitely agree about using NPWT. Other alternatives would be using a different type of pouch. We can see she has erosion from the fistula drainage, but also contact dermatitis on the periphery due to the Eakins' adhesive chemicals. Coloplast has a fistula and management system that might have a better wear time and Hollister has a wound drainage collector that also might have a better wear time than the Easkins pouch. When using NPWT, consider using Dermatac drape which is silicone, as it will be more skin friendly than traditional drapes.
Sep 1, 2021
Samantha Kuplicki
This situation, as I'm sure you're aware, is very complex --
Where is the anatomical location of the fistulae? Proximal jejunum, more distal?

What is her nutrition like? Can she eat? What does she eat? ---is she being treated like a short gut/High output fistula patient---being given mostly electrolyte solution with limited hypotonic solution and being fed 'constipating' foods such as applesauce, marshmallows, cheese, psyllium fiber, etc?

Is she on any sequestering agents like questran to decrease acidity of effluent or omeprazole to combat hypersecretion? Is she on lactobacillus?

What is her mobility like?

What is her underlying condition and prognosis?

What is her insurance? Without a wound bed, NPWT will not be approved, as fistula management is not a reimbursed indication (though can be helpful in specific situations to isolate a fistula from surrounding tissue). I don't see a wound bed, but do see two see two areas that appear to be EC fistulae.

She appears to have lichenification from chronic exposure to bile acid and likely yeast/possibly superimposed bacterial issues starting.

I would say she needs to be inpatient for a time to have 24 hour care for this with a wound or Ostomy specialist available to get it stabilized so that a more traditional appliance can function.

I would treat this with a wound manager type appliance/eakin pouch combined with a fenestrated red rubber catheter connected to wall suction while working to thicken her effluent and heal the skin.
Sep 2, 2021
Samantha Kuplicki
Similar to the image here, may need two separate appliances for each fistulae in lieu of one large appliance.
Sep 2, 2021
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