A 29-year-old male presented with abdominal pain and high grade fever. A diagnosis of septic shock and generalized peritonitis was made. Fluid resuscitation was performed and vasopressin was administered, followed by laparotomy. Intraoperatively, severe adhesions were found, with multiple tubercles covering peritoneal wall and intestinal serosa. Rinsing of the peritoneal cavity, tube ileostomy at the perforated intestine, and drain placement were performed. Oral antituberculosis therapy was initiated postoperatively. On postoperative Day 15, intestinal contents were excreted through the laparotomy wound and postdrain wound, as shown in Fig. 1. The patient had developed multiple ECF with a total output of 1500 mL/24 h (Fig. 1).
After unsatisfactory results using conservative wound care for 31 days, as shown in Fig. 2, NPWT was used on the fistulas and the wound surrounding the fistulas, using intermittent pressure of -70 mmHg (5 min of negative pressure and 2 min of rest). Local debridement was performed and new granufoam was reapplied on the wound surface once every 3 days (Figs 2 and 3).
One week after treated using NPWT, the output had decreased to 500 mL/24 h. Productions from the fistulas were able to be controlled as not to spill to the peri-fistula wound. Two weeks post NPWT treatment, the productions had decreased to 70 mL/24 h, and ECF production could easily be controlled to spil into a regular stoma bag. One month following the end of NPWT treatment, healthy granulation tissue had been promoted, and only one active low output fistula left. Keystone flap was performed to facilitate closure. No complications occurred (Figs 4-7).