Enterocutaneous fistula management and clinical nutrition in sepsis of abdominal wall incisional hernia. Tips, tricks and literature revision

Background: The Enterocutaneous Fistula (ECF) treatment requires a multidisciplinary approach and high costs, and shows critical morbidity and mortality rates. For these reasons, it is one of the most challenging problems in colorectal and incisional hernia surgery. Methods: This article synopsizes the current classification systems’ successful management and provides an in-depth review of septic source surgical control, Clinical Nutrition, Hyper Baric Oxygen Therapy (HBOT) and negative pressure (VAC), output quantity management, wound care, operative timeline, and considerations such as Inflammatory Bowel Disease (IBD), and Enteroatmospheric Fistula (EAF). Result: We report a 71-year-old septic fistulated male with an incisional hernia, and chronic medullary dysplasia. This study compares our results with the literature. This case concerns a very complex and long-lasting clinical scenario because of erythropoietic and immunity systems default that led the patient to death. The use of negative pressure therapy to manage abdominal fistula is still controversial. Patients suffering from enterocutaneous fistula require adequate nutritional support to fight hypercatabolism due to the fistula’s inflammation, fluids, proteins, and salts loss. Conclusions: An aggressive multidisciplinary approach, including prosthesis explantation are needed. Clinical nutrition starts with TPN (Total Parenteral Nutrition) followed by EN (Enteral Nutrition) as soon as possible. Moreover, VAC and HBOT therapies are useful to treat this life-threatening condition.