Negative-Pressure Therapy for an Unformed Small-Bowel Fistula: Clinical Case
https://doi.org/10.24060/2076-3093-2026-16-2-192-197
Abstract
Introduction. Intestinal fistulas remain among the most challenging and discouraging complications in abdominal surgery. Their diverse morphology, profound pathophysiological disturbances of homeostasis, and the complexity of management strategies, ranging from conservative management to surgical intervention, contribute to high mortality and suboptimal treatment outcomes. Aim. This report describes successful conservative treatment of an unformed small-bowel fistula using negative-pressure wound therapy (NPWT).
Materials and methods. We report the case of a 70-year-old woman who developed an unformed small-bowel fistula following closure of a loop protective ileostomy. NPWT was applied to the abdominal wall wound using continuous suction at –70 mmHg. Treatment began with a porous polyurethane sponge and concluded with suction applied without a sponge. This approach resulted in progressive reduction of the wound cavity, a significant decrease in fistula output, and eventual spontaneous closure. The postoperative course, local wound-care technique, medications used, treatment stages, and duration of therapy are described. The patient achieved full recovery with rapid fistula closure.
Results and discussion. A review of the recent literature is provided, including reports on the use of NPWT for gastrointestinal fistulas. Evidence indicates that NPWT may facilitate spontaneous closure of gastrointestinal fistulas or promote formation of a low-output, well-defined fistula suitable for elective surgical repair. These outcomes are attributed to drainage of purulent cavities, reduction of fistula output, protection of the abdominal wall skin, and progressive reduction of wound size. These are recognized effects of negative pressure on soft tissues.
Conclusion. Negative-pressure therapy is an appropriate option for unformed small intestinal fistulas and frequently enables successful conservative management.
Keywords
unformed bowel fistula,
negative-pressure wound therapy,
ileostomy,
negative-pressure therapy,
surgical anastomosis,
postoperative complications
Supporting agencies: This work is not funded.
About the Authors
N. A. Trifanov
Kuban State Medical University
Russian Federation
Russian Federation
Nikolay A. Trifanov — Cand. Sci. (Med.), Department of Faculty and Hospital Surgery
Krasnodar
K. I. Popandopulo
Kuban State Medical University
Russian Federation
Russian Federation
Konstantin I. Popandopulo — Dr. Sci. (Med.), Department of Faculty and Hospital Surgery
Krasnodar
E. E. Aloyan
Kuban State Medical University
Russian Federation
Russian Federation
Edgar E. Aloyan — Resident, Department of Faculty and Hospital Surgery
Krasnodar
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21. Fedyushkin V.V., Baryshev A.G., Pyatakov S.N., Gumenyuk S.E., Alukhanyan O.A., Bensman V.M. Vacuum therapy in complex treatment of purulent-necrotic diseases of soft tissues: clinical cases. Kuban Scientific Medical Bulletin. 2023;30(2):102–15 (In Russ.). DOI: 10.25207/1608-6228-2023-30-2-102-115
22. Cherkasov M.F., Galashokyan K.M., Startsev Yu.M., Cherkasov D.M., Melikova S.G., Rudkova K.E. Ten years’ experience of vacuum systems in treatment of complicated postoperative wounds of various etiologies. Medical Herald of the South of Russia. 2024;15(3):106–14 (In Russ.). DOI: 10.21886/2219-8075-2024-15-3-106-114
23. Barmina T.G., Khamidova L.T., Zabavskaya O.A., Selina I.E., Yartsev P.A., Sharifullin F.A., et al. Diagnosis of gastrointestinal fistulas in pancreatic necrosis by X-ray and computed tomography. Bulletin of the Medical Institute “REAVIZ”: Rehabilitation, Doctor and Health. 2024;14(5):128–36 (In Russ.). DOI: 10.20340/vmi-rvz.2024.5.MIM.4
24. Ivanov F.V., Kotiv B.N., Dzidzava I.I., Barinov O.V., Gumilevskiy B.Yu. Application of local negative pressure in peritonitis in patients at high risk of intestinal fistula development. International Research Journal. 2024;1(139):1–7 (In Russ.). DOI: 10.23670/IRJ.2024.139.106
25. Lee T.G., Kim D.H., Yun H., Ryu D.H. Successful endoscopic vacuum therapy for the lateral duodenal fistula. Asian J Surg. 2022;45(9):1807–8. DOI: 10.1016/j.asjsur.2022.05.034
26. Doday V.A., Borisov D.L., Terushkova Z.I. Experience in vacuum therapy of incomplete intestinal fistula treatment. Wounds and wound infections. The prof. B.M. Kostyuchenok journal. 2016;3(4):24–33 (In Russ.). DOI: 10.25199/24089613-2016-3-4-24-33
27. Varganov MV, Larin VV, Tselousov AA, Bogachik AP, Yaroshenko VP. The effectiveness of vacuum therapy and meglumine sodium succinate in unformed fistulas of the gastrointestinal tract (clinical observations). Pirogov Russian Journal of Surgery. 2023;10:150– 4 (In Russ.). DOI: 10.17116/hirurgia2023101150
28. Solis-Pazmino P., da Silva L.O., Huiracocha J.Q., Saldanha L.H., Avila A., Ribeiro G., et al. Successful outcome of combined surgical and negative pressure therapy in complex enterocutaneous fistulas: a case report. J Surg Case Rep. 2023;2023(3):rjad161. DOI: 10.1093/jscr/rjad161
29. Varzin S.A., Apereche B.S., Avdeev A.M., Tsochvrebova Z.M., Gribanov V.V., Krasnopeeva M.K. Proper experience of complex treatment of a patient with complicated Crohn’s disease: application of vacuum duodenal obturation in closing high small intestinal fistulas. Journal of Experimental and Clinical Surgery. 2023;16(1):70–9 (In Russ.). DOI: 10.18499/2070-478X-2023-16-1-70-79
30. Repin M.V., Trushnikov D.V., Tronin D.A., Shchetkina I.N., Sablin E.E. Successful closure of esophagogastric anastomotic leak using endoscopic vacuum therapy. Perm Medical Journal. 2025;42(1):119–24 (In Russ.). DOI: 10.17816/pmj421119-124
31. Shevchenko D.A., Lebedeva D.V., Drokova A.S., Grigoryev E.G. Efficacy of vacuum aspiration therapy in a patient with broncho-esophageal and mediastino-esophageal fistula: a clinical case. Siberian Medical Review. 2024;6:113–6 (In Russ.). DOI: 10.20333/25000136-2024-6-113-116
32. de Souza S.C., Meneses D.A. Multiple intestinal fistulization managed with vacuum therapy. Plast Reconstr Surg Glob Open. 2025;13(7):e6874. DOI: 10.1097/GOX.0000000000006874
33. Seternes A., Rekstad L.C., Lossius W., Wasmuth H.H. A method for treatment of deep and superficial enteroatmospheric fistulas in an open abdomen, ChimneyVAC: Ten years experience. World J Surg. 2024;48(5):1066–74. DOI: 10.1002/wjs.12156
34. Wainstein D.E., Calvi R.J., Rezzonico F., Deforel M.L., Perrone N., Sisco P. Management of enteroatmospheric fistula: A ten-year experience following fifteen years of learning. Surgery. 2023;173(4):1079–85. DOI: 10.1016/j.surg.2022.12.001
35. Keshvari A., Mollamohammadi L., Keramati M.R., Behboudi B., Fazeli M.S., Kazemeini A., et al. Assessment of the efficacy of handmade vacuum-assisted sponge drain for treatment of anastomotic leakage after low anterior rectal resection. Updates Surg. 2023;75(4):847–54. DOI: 10.1007/s13304-023-01518-3
36. Kienle P., Magdeburg J.R. Chronic anastomotic leak after low rectal resection-an unsolved problem?. Chirurg. 2021;92(7):605–11. DOI: 10.1007/s00104-021-01400-1
37. Nyamuryekunge M.K., Yango B., Mwanga A., Ali A. Improvised vacuum assisted closure dressing for enterocutenous fistula, a case report. Int J Surg Case Rep. 2020;77:610–3. DOI: 10.1016/j.ijscr.2020.11.049
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For citations:
Trifanov N.A., Popandopulo K.I., Aloyan E.E. Negative-Pressure Therapy for an Unformed Small-Bowel Fistula: Clinical Case. Creative surgery and oncology. 2026;16(2):192-197. (In Russ.) https://doi.org/10.24060/2076-3093-2026-16-2-192-197
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