A 34-year-old male has been in the ICU for almost three weeks and has undergone several laparotomies following complex abdominal trauma. He appears to have nasogastric feed emanating from his dehisced laparotomy wound and has developed a vasopressor requirement.
Give the likely diagnosis, and outline the principles of its management.
Enterocutaneous fistula (ECF) with inadequate source control
Or ECF with undrained collection
Or ECF with septic shock
Definitive surgery - may be much later
Not well answered. Many candidates described a generic approach to intra-abdominal sepsis without considering the specific issues related to enterocutaneous fistulae.
Cohen, Wess A., et al. "The complex surgical abdomen: What the nonsurgeon intensivist needs to know." Journal of intensive care medicine 31.4 (2016): 237-242.
Edmunds Jr, L. Henry, G. M. Williams, and Claude E. Welch. "External fistulas arising from the gastro-intestinal tract." Annals of surgery 152.3 (1960): 445.
Lundy, Jonathan B., and Josef E. Fischer. "Historical perspectives in the care of patients with enterocutaneous fistula." Clinics in colon and rectal surgery 23.3 (2010): 133.
Chapman, Richard, Robert Foran, and J. Englebert Dunphy. "Management of intestinal fistulas." The American Journal of Surgery 108.2 (1964): 157-164.
Evenson, Amy R., and Josef E. Fischer. "Current management of enterocutaneous fistula." Journal of gastrointestinal surgery 10.3 (2006): 455-464.
Gribovskaja-Rupp, Irena, and Genevieve B. Melton. "Enterocutaneous fistula: proven strategies and updates." Clinics in colon and rectal surgery 29.2 (2016): 130.
Hutchins, Robert R., et al. "Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery." World journal of surgery 28.2 (2004): 137-141.
Green, Gemma, et al. "Emergency laparotomy in octogenarians: A 5-year study of morbidity and mortality." World journal of gastrointestinal surgery 5.7 (2013): 216.
Solomkin, Joseph S., et al. "Guidelines for the selection of anti-infective agents for complicated intra-abdominal infections." Clinical Infectious Diseases 37.8 (2003): 997-1005.
Montravers, P., et al. "Emergence of antibiotic-resistant bacteria in cases of peritonitis after intraabdominal surgery affects the efficacy of empirical antimicrobial therapy." Clinical Infectious Diseases 23.3 (1996): 486-494.
Latifi, R., et al. "Enterocutaneous fistulas and a hostile abdomen: reoperative surgical approaches." World journal of surgery 36.3 (2012): 516-523.
Galie, Kathryn L., and Charles B. Whitlow. "Postoperative enterocutaneous fistula: when to reoperate and how to succeed." Clinics in colon and rectal surgery 19.4 (2006): 237.