A rare approach to entero-atmospheric fistula.

Meshikhes, Abdul-Wahed Nasir; Al-Hariri, Abdulrazzak; Al-Zahir, Ali Ahmed; Al-Nahawi, Mamdouh

PATIENT Female, 60 FINAL DIAGNOSIS: Recurrent incisional hernia Symptoms: - MEDICATION - Clinical Procedure: Limited ileo-cecal resection Specialty: Surgery. OBJECTIVE Diagnostic/therapeutic accidents. 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.