Delayed primary fascia closure of Björck grade 4 open abdomen with enteroatmospheric fistulas after repeated surgery for adhesive small bowel obstruction: a case report
| Autor: | Kaoru Sasaki, Tsuyoshi Enomoto, Tatsuya Oda, Mitsuru Sekido, Yoshimasa Akashi, Yohei Owada, Jaejeong Kim, Koichi Ogawa, Yusuke Ohara, Osamu Shimomura, Katsuji Hisakura, Shinji Hashimoto, Kazuhiro Takahashi |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Fistula RD1-811 medicine.medical_treatment Enteroatmospheric fistula Wound care Laparotomy Negative-pressure wound therapy Adhesives Abdomen Case report medicine Humans Fascia Open abdomen business.industry Abdominal wall defect Small bowel obstruction Abdominal Cavity Abdominal Wound Closure Techniques General Medicine Middle Aged Short bowel syndrome medicine.disease Surgery Bowel obstruction medicine.anatomical_structure Jejunostomy Björck classification business |
| Zdroj: | BMC Surgery, Vol 21, Iss 1, Pp 1-7 (2021) BMC Surgery |
| ISSN: | 1471-2482 |
| Popis: | Background An open abdomen with frozen adherent bowels is classified as grade 4 in Björck’s open abdomen classification, and skin grafting after wound granulation is a typical closure option. We achieved delayed primary fascia closure for a patient who developed open abdomen with enteroatmospheric fistulas due to severe adherent small bowel obstruction. We present here the details of his management. Case presentation A 52-year-old man suffered acute abdominal pain during a flight and received an emergency laparotomy due to adhesive small bowel obstruction. Repeated laparotomies were required, and later open abdomen and proximal site jejunostomy were selected. After negative pressure wound therapy, he was transferred to our institution. Two enteroatmospheric fistulas emerged on the exposed intestine, and we diagnosed the condition as a Björck grade 4 open abdomen. After 8 months of wound care and parenteral nutrition, we decided to attempt primary wound closure because the patient required permanent oral restriction and total parenteral nutrition due to short bowel syndrome. A circular incision along the circumference of the exposed bowel allowed us to take a safe approach into the abdominal cavity. We removed the intestinal adhesions completely and resected the bowels, including the fistulas and anastomosed parts. Finally, the abdominal wall defect was reconstructed using the component separation technique, and the patient was discharged without an ostomy. Conclusions Primary fascia closure for grade 4 open abdomen is hard, but leaving a long interval before radical surgery and applying pertinent wound management may help solve this adverse situation. |
| Databáze: | OpenAIRE |
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