{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:17:34Z","timestamp":1791235054764,"version":"4.1.0"},"reference-count":13,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Trauma Surg Acute Care Open"],"accepted":{"date-parts":[[2019,12,8]]},"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>With the popularization of damage control surgery and the use of the open abdomen, a new permutation of fistula arose; the enteroatmospheric fistula (EAF), an opening of exposed intestine spilling uncontrollably into the peritoneal cavity. EAF is the most devastating complication of the open abdomen. We describe and analyze a single institution\u2019s experience in controlling high-output EAFs in patients with peritonitis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed 189 consecutive procedures to achieve and maintain definitive control of 24 EAFs in 13 patients between 2006 and 2017. EAFs followed surgery for either trauma (seven patients) or non-traumatic abdominal conditions (six patients). All procedures were mapped onto an operative timeline and analyzed for: success in achieving definitive control, number of reoperations, and feasibility of bedside procedures in the surgical intensive care unit. The end point was controlled enteric drainage through a healed abdominal wound.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There was a mean delay of 8.5 days (range 2\u201346 days) from the index operation until the EAF was identified. Most EAFs required several attempts (mean: 2.7 per patient, range 1\u20137) until definitive control was achieved. Multiple reoperations were then required to maintain control (mean: 13). While the most effective techniques were endoscopic (1) and proximal diversion (1), these were applicable only in select circumstances. A \u2018floating stoma\u2019 where the fistula edges are sutured to an opening in a temporary closure device, while technically effective, required multiple reoperations. Tube drainage through a negative pressure dressing (tube vac) required the most maintenance usually through bedside procedures. Primary closure almost always failed. Twelve of the 13 patients survived.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>An EAF is a highly complex surgical challenge. Successful source control of the potentially lethal ongoing peritonitis requires tenacity and tactical flexibility. The appropriate control technique is often found by trial and error and must be creatively tailored to the individual circumstances of the patient.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/tsaco-2019-000381","type":"journal-article","created":{"date-parts":[[2019,12,31]],"date-time":"2019-12-31T11:45:10Z","timestamp":1577792710000},"page":"e000381","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Challenge of uncontrolled enteroatmospheric fistulas"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3219-8923","authenticated-orcid":false,"given":"Daniel Jonathan","family":"Gross","sequence":"first","affiliation":[{"name":"Surgery, State University of New York Downstate Medical Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael C","family":"Smith","sequence":"additional","affiliation":[{"name":"Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bardiya","family":"Zangbar-Sabegh","sequence":"additional","affiliation":[{"name":"Surgery, Kings County Hospital Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth","family":"Chao","sequence":"additional","affiliation":[{"name":"Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Chang","sequence":"additional","affiliation":[{"name":"Surgery, State University of New York Downstate Medical Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Boudourakis","sequence":"additional","affiliation":[{"name":"Surgery, Kings County Hospital Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muthukumar","family":"Muthusamy","sequence":"additional","affiliation":[{"name":"Surgery, Kings County Hospital Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valery","family":"Roudnitsky","sequence":"additional","affiliation":[{"name":"Surgery, Kings County Hospital Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Surgery, Kings County Hospital Center, Brooklyn, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,12,31]]},"reference":[{"key":"2025081711062582000_4.1.e000381.1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800770133"},{"key":"2025081711062582000_4.1.e000381.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2009.05.025"},{"key":"2025081711062582000_4.1.e000381.3","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1001\/jamasurg.2013.2514","article-title":"Independent predictors of enteric fistula and abdominal sepsis after damage control laparotomy: results from the prospective AAST open abdomen registry","volume":"148","author":"Bradley","year":"2013","journal-title":"JAMA Surg"},{"key":"2025081711062582000_4.1.e000381.4","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.ijso.2016.10.003","article-title":"Enteroatmospheric fistulae in open abdomen: management and outcome \u2013 single center experience","volume":"5","author":"Rasilainen","year":"2016","journal-title":"Int J Surg Open"},{"key":"2025081711062582000_4.1.e000381.5","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1097\/TA.0000000000001452","article-title":"Open abdomen with vacuum-assisted wound closure and mesh-mediated fascial traction in patients with complicated diffuse secondary peritonitis: a single-center 8-year experience","volume":"82","author":"Tolonen","year":"2017","journal-title":"J Trauma Acute Care Surg"},{"key":"2025081711062582000_4.1.e000381.6","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1016\/j.jamcollsurg.2014.11.020","article-title":"Open abdomen with concomitant enteroatmospheric fistula: attempt to rationalize the approach to a surgical nightmare and proposal of a clinical algorithm","volume":"220","author":"Di Saverio","year":"2015","journal-title":"J Am Coll 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ileostomy","volume":"49","author":"Rebibo","year":"2017","journal-title":"Endoscopy"},{"key":"2025081711062582000_4.1.e000381.12","first-page":"184","article-title":"[Exposed fistula of the small intestine, a complication of peritonitis or laparotomy. Apropos of 120 cases]","volume":"40","author":"Levy","year":"1986","journal-title":"Ann Chir"},{"key":"2025081711062582000_4.1.e000381.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2009.06.028"}],"container-title":["Trauma Surgery &amp; Acute Care Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/tsaco-2019-000381","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T18:06:33Z","timestamp":1755453993000},"score":1,"resource":{"primary":{"URL":"https:\/\/tsaco.bmj.com\/lookup\/doi\/10.1136\/tsaco-2019-000381"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2019,12,31]]},"published-print":{"date-parts":[[2019,12]]}},"alternative-id":["10.1136\/tsaco-2019-000381"],"URL":"https:\/\/doi.org\/10.1136\/tsaco-2019-000381","relation":{},"ISSN":["2397-5776"],"issn-type":[{"value":"2397-5776","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,12]]}}}