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Development of an enteroatmospheric fistula (EAF) in the midst of an open abdomen represents a surgical nightmare, with an extremely challenging critical care problem set, including the full spectrum of surgical, metabolic, nutritional, and nursing issues. Spontaneous closure is rare, as there is no fistula tract, and there is a lack of wellvascularized overlying tissue. For these reasons, acute fistula management should aim to completely divert fistula output, protect the surrounding viscera, and allow for the granulation of exposed bowel. This is difficult to achieve because of the extreme frailty of the surrounding tissues, which are chronically injured by enteric fluids, and the multiple systemic derangements of the patient, driven by severe dehydration, electrolyte and acid/base disturbances, a hypercatabolic status, and ongoing sepsis. Despite the advancements in critical care and surgical management, EAF-related …