This case report details the use of The InsidesTM Systemfi to rehabilitate “Mary”s1‘ distal bowel, and test functional continence, with the goal of preparing her for reversal of her double-barrel ileostomy, formed as a part of her care pathway to treat multiple internal fistulae secondary to Diverticular disease2.
This report presents the case of Ray, a 65-year old male who developed a small bowel enteroatmospheric fistula (EAF) and intra-abdominal sepsis following adhesiolysis surgery for a small bowel obstruction. Ray subsequently spent 5 months in hospital on Total Parenteral Nutrition (TPN) and receiving wound care, while he awaited a fistulotomy. When the surgery failed, Ray was transferred for specialist management at the New Zealand Intestinal Failure Unit, and The InsidesTM Systemfi was introduced to accelerate his recovery.
Since launching, we have received a number of enquiries about our Chyme Reinfusion System from Clinicians who have patients with High Output Enteroatmospheric Fistulas (EAF), only to then be updated that the patient has suffered a severe complication and is no longer available for treatment. High output EAFs are catastrophic conditions with high mortality rates, from 20% to 30% (1).
An enterocutaneous fistula (ECF) or an enteroatmospheric fistula (EAF) is a catastrophic complication requiring intense care and optimized nutrition to help accelerate the patient’s journey to recovery.
An ECF is an abnormal connection or tract (fistula) that develops between the intestine (entero) and the skin (cutaneous). An EAF is a special type of ECF where the intestines surface through the skin, exposing the intestines to the atmosphere and external environment (atmospheric).
Chyme (“/kʌɪm/”) is the medical term used to describe the pulpy and semi-fluid composition of partly undigested food, fluid, stomach acid/gastric juices (hydrochloric acid), and digestive enzymes such as pancreatic enzymes and bile. Chyme is initially created in the stomach through both mechanical and chemical processes and passed on into the small intestine for absorption. Chyme is a critical component of gut health and the digestive system. It contains valuable digestive secretions crucial in the maintenance of fluid, electrolyte balance and gut biome.
Chyme Reinfusion (CR) is a practice in the management of patients with High-Output Enterocutaneous Fistulas, and High-Output Enterostomies. Chyme Reinfusion enables patients to reestablish oral feeding and wean off the Parenteral Nutrition (PN) in as little as 3 days (1), resulting in significant health economic benefits and improvements in quality of life (QoL).
Ray, a father and grandfather, had been physically active, regularly helped in his community and loved his job as a barber.
Following a routine operation for a small bowel obstruction, Ray developed an Enteroatmospheric Fistula1. Complications including malnutrition and sepsis resulted in a serious deterioration of Ray’s health and many months spent in hospital.