Complex intestinal fistula treatment and care: A case report and literature review

Rationale: Abdominal cocoon is an uncommon abdominal disease. Intestinal rupture complicated with intestinal fistula rarely occurs in patients with abdominal cocoon.

Patient concerns: A 51-year-old man was referred to hospital, with a 4-hour history of abdominal injuries caused by traffic accident. Intraoperatively, the small intestine in the abdominal cavity was surrounded by dense, tough, grayish-white fibrous tissue. There were the rupture of 2 sites in the ileum. The ileum was anastomosed side-to-side using a cutting and closing device. The patient was postoperatively transferred to the intensive care unit and received ventilator-assisted breathing, along with anti-infection and supportive treatments. On the 10th day after surgery, grass green turbid fluid of approximately 150 mL was extracted from the abdominal drainage tube. The secondary laparotomy was performed on the 12th day post-surgery, revealing a 1.5 cm diameter fistula at the end of the ileum.

Intervention and outcomes: Nursing strategies included ensuring optimal mechanical ventilation for oxygenation, utilizing Li's double cannula for continuous abdominal irrigation and negative pressure drainage to prevent abdominal abscess formation, emphasizing the importance of enteral nutrition, implementing direct suture treatment to manage retrograde infection and expedite stoma healing, and employing Li's double cannula and vacuum-assisted closure technique to promote incision healing. After 48 days secondary post-surgery, the incision was fully healed, and the patient was discharged home with the stoma bag. Five months later, he was readmitted to the hospital, and the stoma was reversed.

Lessons: Intestinal fistula poses a remarkable challenge after abdominal cocoon surgery, typically manifesting 4 to 5 days postoperatively. However, in this case, it occurred on the 10th day, highlighting the critical role of vigilant monitoring of drainage fluid color and volume in postoperative care. Navigating the complex management of intestinal rupture in abdominal cocoon necessitates a more efficacious approach, highlighting the importance of accumulating comprehensive nursing expertise through such cases.