Improvised enterocutaneous fistula drainage system in a child with typhoid perforation

Abstract

About 80% of enterocutaneous fistulas (ECF) occur as a complication of abdominal surgery, while 24% of operated patients with typhoid perforation and 90% of non operated ones die. Uneven skin surface around ECFs do not allow pouch adherence and adhesive routinely slip due to sweat in our hot tropical climates. Frequent gauze dressing with adhesives, in high output fistula contributes to jeopardy of skin integration. Objective: A resort in managing a high output ECF from typhoid perforation in a seven year old girl with skin maceration, using improvised fistula drainage system for protective skin care, odour control and cost containment. Method: A simple balloon-coned fistula drainage system using a balloon and a soft conical cap found in some intravenous fluid non-collapsible container is used. It attaches well to uneven fistula stoma. Results: The device prevented fistula effluent leakage and further skin breakdown while enhancing healing of surrounding skin. It greatly minimizes odour and easy drainage estimation. Conclusion: The improvised drainage system is cost effective in containing skin maceration and healing of surrounding skin and ECF, resulting from closure of typhoid perforations. It apposed well to fistula stoma, diminishes odour but channelled meagre resources to nutrition and medication.