Large hernia caused by entero-cutaneous fistula after laparoscopic adhesiolysis: Report of a case

Abstract

A young and otherwise healthy man was admitted to a district hospital, for treatment of adhesional disease developed as a result of complicated appendectomy two decades before. He was treated by laparoscopy, during which seven small-bowel loops were released from the abdominal wall. Nine days later, laparotomy became necessary because of recurrent intestinal obstruction. This laparotomy revealed two small bowel leakages in the right lower abdomen with purulent peritonitis. Resection of the leaking small bowel loops was performed. When the patient was transferred to our department, he was in a serious condition with persistent fever and a few days later multiple entero-cutaneous fistulae appeared in the wound, causing a large abdominal wall defect of 31 × 16 cm. Following 8 weeks of fistula-shrinking, the size of the defect was reduced to 17 × 9 cm. After resection of intestinal loops including multiple fistulae, a large abdominal wall-defect persisted. Hernia repair was performed 8 months after resection by intraperitoneal implantation of a large 30 × 40 cm ePTFE prosthetic patch (Gore-Tex®), fixed by transfascial subcutaneous sutures. Follow-up at 20 months revealed restoration of abdominal wall integrity and good general health.