Use of a Fistula Isolation Device, Ostomy Appliance, and Negative Pressure Wound Therapy in a Hostile Abdomen

Introduction: A 70–year-old female with an extensive medical and surgical history related to Crohn’s disease was admitted with an obstructing chronic terminal ileum unresponsive to maximum medical therapy. The patient underwent surgical intervention, which resulted in an anastomotic leak and incisional dehiscence. Re-exploration led to the creation of an ileostomy in close proximity to a large midline abdominal wound. The ileostomy became ischemic, retracted into a skin fold, and leaked enteric content through a tunnel under intact skin into the midline abdominal wound.

Methods: Negative pressure wound therapy (NPWT*) was utilized to granulate and contract the abdominal wound while ostomy appliances, along with accessory products, were used to contain effluent. The ostomy appliances leaked several times a day, due to location and structure, causing severe peristomal skin breakdown. A fistula isolation device was used as a wall between the stoma and the abdominal wound to prevent effluent from entering the wound bed and direct it away from the peristomal skin while utilizing NPWT at -125mmHg. Dressings were changed 3 times per week.

Results: Contraction of wound edges along with a significant presence of granulation tissue was noted after the use of the fistula isolation device in conjunction with NPWT. Peristomal skin breakdown resolved when the fistula isolation device and drainable ostomy appliance were used as a conduit for the effluent from the stoma. NPWT was discontinued after approximately 2 months. Three months post presentation, the patient was discharged and transitioned to home health care.

Conclusion: The use of a fistula isolation device, in conjunction with NPWT and an appropriate ostomy appliance, produced positive patient outcomes (such as patient-reported satisfaction, promotion of wound healing, resolution of peristomal skin damage, reduced use of pain medication, and discharge to home with visiting nurses) in this patient.