Enteroatmospheric Fistula: A Challenge of Acute Care Surgery

Enteroatmospheric fistula (EAF) is defined as an enteric leak into an open abdomen. Its occurrence is one of the most feared complications for the acute care surgeon. The incidence of EAF is currently increasing due to a more liberal use of damage control surgery. Daily management is burdened by high complication and mortality rates and relevant costs for the national health system. Early identification and referral to specialized centers are critical aspects for better outcomes. The approach should be based on a step-up process in which surgery is the light at the end of the tunnel. The first steps should focus on clinical assessment and optimization of metabolic, septic and anatomical aspects. The intermediate step before definitive surgery is demanding in terms of time and resources and relies on different surgical techniques for fistula management. Definitive surgery can be planned only when timing and clinical condition are respected. Acute care surgeons must be aware that the clinical pathway of EAF patients is not always straightforward. This chapter aims to overview the critical aspects of classification and management of EAF and is designed to be a daily practice guide, with clinical and surgical insights relevant not only to experienced acute care surgeons.