Management of Septic Open Abdomen in a Morbid Obese Patient with Enteroatmospheric Fistula by Using Standard Abdominal Negative Pressure Therapy in Conjunction with Intrarectal One.

Fahri Yetisir,Muhittin Aygar,Gokhan Osmanoglu,Mehmet Özer,A Ebru Salman,Hasan Zafer Acar

doi:10.1155/2015/293946

Abstract

Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging. We would like to report the management of septic OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. We would also like to emphasize, in this case, the conversion of EAF to ileostomy by the help of second Negative Pressure Therapy (NPT) on ostomy side, and the chance of new EAF occurrence was reduced with intrarectal NPT. Case Presentation. 62-year-old morbid obese woman became an OA patient with EAF after strangulated recurrent giant hernia. EAF was converted to ostomy with pezzer drain by the help of second NPT on ostomy. Colonic distention was reduced with the third NPT application via rectum. Abdominal reapproximation anchor (ABRA) system was used for delayed abdominal closure. Conclusions. Using the 2nd NPT on ostomy side may help in the maturation of the ostomy created in a difficult condition in an open abdomen. Using the 3rd NPT through rectum may decrease the chance of EAF formation by reducing the pressure difference between intraluminal pressure and extraluminal pressure in hollow viscera.

Highlights

Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging
We would like to report management of OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair
Two Negative Pressure Therapy (NPT) systems were applied; one was standard abdominal NPT (Figure 2), and the second one was performed on the ileostomy opening where the EAF was directed with pezzer tube

Summary

Introduction

Incisional hernias (IH) are a frequent complication after all abdominal surgery, with an incidence of 10–23% [1, 2]. Obesity and chronic diseases are predisposing factors for developing IH with the potential complication of small bowel obstruction and other morbidities [3]. IH enlarge over time and can cause serious complications like bowel obstruction due to incarceration or strangulation. Open abdomen (OA) management is a life-saving and challenging strategy in situations such as the abdominal compartment syndrome (ACS), damage-control surgery, and severe generalized peritonitis [5, 6]. Management of patients with an open abdomen and an enteroatmospheric fistula (EAF) is very challenging. We would like to report management of OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. Chance of new EAF occurrence during long OA period was reduced by decreasing colonic distention with intrarectal NPT, first time in the literature (Figure 4)

Presentation of Case

Discussion

Conclusion