Management of postoperative multiple enteroatmospheric fistulas

Enteroatmospheric fistula (EAF), as a distinct type of enterocutaneous fistula, carries a high mortality risk and presents exceptional management challenges. This case report details the complex diagnostic and therapeutic journey of a 70-year-old male patient who developed multiple EAFs following laparoscopic tension-free repair of an abdominal wall hernia. The patient had a 16-year history of a large reducible incisional hernia. On the second postoperative day, abdominal pain developed with drainage of copious dark green fluid. Computed tomography revealed intestinal fistula formation. Following unsuccessful conservative management, the patient was transferred to a tertiary hospital where procedures including adhesiolysis, abdominal abscess incision and drainage, and patch removal were performed. Intraoperatively, one fistula opening in the transverse colon and two ruptured fistula openings in the mid-small intestine were identified. Subsequently, the patient was transferred to our institution. Treatment included fasting, acid suppression, parenteral nutrition support, and irrigation drainage. We have innovatively adopted a comprehensive treatment regimen comprising three-dimensional-printed fistula stents, triple-lumen irrigation, and the reinfusion of intestinal fluid. Five months later, the patient was readmitted and underwent successful radical surgery. Postoperatively, a mixed infection with Acinetobacter baumannii and Klebsiella pneumoniae was identified; following antibiotic adjustment, the patient’s temperature returned to normal.