What is the suggested management for a burst abdomen where high output bowel fistula are present?

The suggested management for a burst abdomen with high output bowel fistula involves the application of a wound manager. This approach is particularly relevant in cases where there is significant wound dehiscence and ongoing output from the fistula.

Utilizing a wound manager helps in several important ways. It allows for the management of the fistula output while also providing a suitable environment for the surrounding tissue to heal. In such cases, direct closure of the abdomen may not be feasible or appropriate due to the risk of further complications. A wound manager can also help protect the surrounding skin from the effects of high-volume output, which can lead to skin breakdown and further complications.

Other management options such as reinforced sutures and immediate exploratory surgery would not be advisable in this scenario due to the complexities involved and the potential for increasing intra-abdominal pressure, which can exacerbate the situation. Antibiotic therapy may support the management of infection but does not address the immediate challenge of the burst abdomen and the fistula itself, which is the primary concern. Hence, employing a wound manager is a more prudent and effective approach for promoting healing and managing the high output from the fistula.