Nursing management of multiple enterocutaneous fistulae located in the center of a large open abdominal wound: a case study.

Large abdominal wounds complicated by enterocutaneous fistulae require creative pouching techniques and wound care. Knowledge of containment devices, principles of pouching and appropriate wound management can promote an optimal level of care. After undergoing debridement and drainage of intra-abdominal and pelvic abscesses, a 55 year old surgical patient was left with a large ECF/wound requiring a creative pouching technique. Because the abdominal area was quite extensive, the larger drainable pouches and wound management devices would not accommodate the width of the wound bed. An effective pouching method was achieved using various skin barriers, adhesives and a bowel isolation bag. This system enabled the patient to ambulate and perform many other ADLS while containing moderate to large amounts of effluent. Most of all, this method provided comfort and a sense of dignity while preventing post surgical complications.