JUNE 28 - JULY 2, 2020  
30 years of Care Transitions Across the Full Continuum

PP301 – 914 Days: Multidisciplinary Enterocutaneous Fistula Management in a Long-Term Acute Care Setting

PP301 – 914 Days: Multidisciplinary Enterocutaneous Fistula Management in a Long-Term Acute Care Setting

Enterocutaneous Fistula (ECF) /Enteroatmospheric Fistula (EAF) development carries mortality rate of 6-33% (Kumar et al, 2011).  80-90% of all small intestinal fistulas develop because of surgery with the remaining 10-20% occurring spontaneously due to inflammatory processes, cancer, or radiation.  30% of ECFs close spontaneously with conservative management.  Those that do not close, require surgical closure with a fistula recurrence rate of ~13-34% (Pal, 2018).   Management of patients with ECF is expensive, complex, and dynamic, requiring collaboration among the entire healthcare team to maximize wound healing, functional status, and quality of life.

We reviewed a 63-year-old female who developed an ECF post bariatric surgery.  Her inpatient care spanned two states and 4 facilities with 914 days spent within the Partners Network under the care of multiple Physicians,  Nurses, Dietitians, Therapists, Social Workers, and Case Managers.  Her course was complicated by prolonged critical illness, extensive wound healing requirements, and serious physical debility making her overall prognosis and disposition uncertain.  Her Network-wide course included multiple operative procedures in attempt at fistula takedown, requiring multidisciplinary transition to Brigham and Women’s Hospital.  Over time, her condition stabilized medically.  Emotionally and physically, she started making gains toward independence with her fistula care.

This case study focuses on the importance of multidiscplinary collaboration to make a home discharge with complex gastrointestinal anatomy a reality.

References

Kumar, P., Maroju, N., & Kate, V. (2011).  Enterocutaneous Fistulae:  Etiology, Treatment, and Outcome—a study from South India.   Saudi Journal of Gastroenterology.   Retrieved 2018.

Pal, N. (2017).  Intestinal Fistula Surgery.  Medscape.

William, L., Zolfaghari, S., Boushey, R. (2010). Complications of Enterocutaneous Fistulas and Their Management.  Clin Colon Rectal Surg. 2010 Sep 23(3): 209-220.