2010, Number 1
Necrotizing fasciitis as cause of acute evisceration: report of a case with definitive treatment in one hospitalization, without development of ventral hernia
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ABSTRACTObjective: To report a case of infectious necrosis of the abdominal wall complicated with severe evisceration that required an innovative surgical management.
Setting: Ángeles Hospital, city of Querétaro, Mexico
Design: Case report
Description of the case: Woman, 37-year-old, who 24 h after an open histerectomy was reoperated due to extensive muscular necrosis affecting the lower right abdominal quadrant, with tissular liquefaction and the presence of gas in the affected abdominal wall. Debridation and irrigation with super-oxygenated water was performed twice a day and support measures were provided in the critical care unit. The culture isolated Clostridium and Enterobacter. After 96 h of the first debridation, acute evisceration occurred that was controlled with an intraperitoneal non-sutured polyethylene Bogota bag exceeding 6 cm the peritoneal-muscular defect. Additionally, a 30 × 30 cm pre-muscular polypropylene mesh was used (onlay). The wound was left open and irrigation was continued every 12 h with the super-oxygenated water. Twelve days later, the wound was clean, without secretion, and granulation tissue was developing. She was reoperated through an incision in the premuscular polypropylene mesh, and the Bogota bag was replaced by a retromuscular polypropylene mesh, over the granulation tissue formed thanks to the Bogota bag. This second polypropylene mesh was affixed with transmuscular suture, using clockwise stitches. The cutaneous flap was closed at a second attempt. At one-year follow-up no signs of incisional hernia have been found.
Conclusion: This is a rare case of infectious necrosis of the abdominal wall complicated with severe evisceration that required an innovative surgical management.
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