English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

An enteroatmospheric fistula (EAF) is defined as the presence of an enteric fistula in the middle of an open abdomen with no overlying soft tissue [1]. We describe an alternative approach to the management of EAFs located on the small bowel close to a terminal ileostomy using a covered self-expanding metal stent (CSEMS), which we used in three patients. The median time to discovery of the EAF was 42 days (range 35–55). The median distance between the EAF and the terminal ileostomy was 15 cm (12–20). All patients had been previously managed for EAF using adapted tube vacuum-assisted closure (VAC) (▶Fig. 1). Themedian interval between discovery of the EAF and use of the CSEMSwas 20 days (17–42). Endoscopy was performed via the terminal ileostomy. A guidewire was introduced through the ileostomy and guided beyond the EAF. A colonic CSEMS (Hanarostent HRC, Life Partners Europe, Bagnolet, France) with a diameter of 40–20– 26mm and a length of 24 cm was then placed on either side of the EAF. The position of the stent was checked by direct vision and radiological guidance, and it was then deployed to cover the EAF. The stent was sutured to the edge of the EAF using absorbable sutures to prevent migration. Sutures were placed on the mesh without passing through the coating of the CSEMS (▶Fig. 2; ▶Video1). VAC therapy using white then black foam was placed on the EAF orifice. Postoperative management consisted of changing the VAC therapy every 48–72 hours (▶Fig. 3) and enteral nutrition via a nasojejunal tube. The CSEMS was removed after 1 month. By this time, the EAF had closed in two patients and the CSEMS was easily removed. In the remaining patient, the CSEMS had to be changed because of persistence of the EAF with endoscopic perforation occurring during placement of the second CSEMS. In all three paE-Videos

Combined endoscopic and surgical covered stent placement: a new tailored treatment for enteroatmospheric fistula in patients with terminal ileostomy