Management of complex abdominal wounds with small bowel fistulae: isolation techniques and exudate control to improve outcomes.

Enterocutaneous fistulae associated with abdominal surgery are an extremely troublesome complication. Fistulae that occur in large, open abdominal wounds and connect the wound bed and small bowel are especially prone to complications. Although a variety of management suggestions are available on this subject, few standard methods of management are discussed. The primary goals of care are (1) nursing management of fistula output and wound healing and (2) medical management supporting either spontaneous or surgical closure of the fistula. This article presents case studies of patients with small bowel fistulae located in large abdominal wounds and describes approaches for managing high-output enteric effluent (1-6 L daily) while achieving underlying wound healing. These approaches suggest opportunities for further research, new product development, and adjunctive multidisciplinary approaches.