| Abstrakt: |
Rick (pseudonym) is a 36-year-old man with antithrombin III deficiency, who presented to a tertiary referral hospital with mesenteric ischaemia secondary to a superior mesenteric vein (SMV) thrombosis in May 2016. After undergoing a laparotomy, small bowel resection and formation of an end ileostomy Rick had a stormy post-operative course with complications including multiple intra-abdominal bleeds (in the setting of therapeutic anticoagulation), development of an enterocutaneous fistula (proximal to the ileostomy), bilateral proximal DVTs and a critical care myopathy/neuropathy. He also encountered nerve damage from a cannula to his right hand, which left him with limited movement in that hand. Following surgery, Rick had a frozen open abdomen. The abdominal wound was mainly managed with Eakin® wound management bags. A split skin graft (SSG) was carried out, which necessitated the isolation of the faecal stream from the wound. This was achieved by using the fistula adapter distributed by Ainscorp in order to isolate the output from the fistula and enable the wound to be managed by negative pressure wound therapy (NPWT). Following the SSG, the fistula adapter and NPWT was used for six weeks. This worked very well until the patient started eating solid food. Once Rick started eating solid food the fistula adapter would block at times, causing faeces to leak onto the SSG. Due to fistula leakage onto the wound, the SSG failed and the decision was made to go back to using the Eakin® wound pouch attached to the B. Braun faecal collector bag, which was changed routinely three times per week. Following four weeks in rehabilitation, Rick was discharged home to his family. The community nurses changed Rick's bag routinely three times per week and it was then reduced to twice weekly (they were shown how to do this by the hospital stomal therapist) and Rick's father was also taught how to change the bag as necessary if it leaked between routine changes. [ABSTRACT FROM AUTHOR] |
