ABSTRACT
In this report, we present a case of successful treatment of a bowel fistula in the open abdomen by perforator flaps and an aponeurosis plug. A 70-year-old man underwent total gastrectomy and developed anastomotic leakage and dehiscence of the abdominal wound a week later. He was dependent upon extracorporeal membrane oxygenation, continuous hemodiafiltration, and a respirator. Bowel fluids contaminated the open abdomen. Two months after the gastric operation, a plastic surgery team, in consultation with general surgeons, performed perforator flaps on both sides and constructed, as it were, a bridge of skin sealing the orifice of the fistula. The aponeurosis of the external oblique muscle was elevated with the flap to be used as a plug. The perforators of the flaps were identified on preoperative and intraoperative ultrasonography. This modality allowed us to locate the perforators precisely and to evaluate the perforators by assessing their diameters and performing a waveform analysis. The contamination decreased dramatically afterwards. The bare areas were gradually covered by skin grafts. The fistula was closed completely 18 days after the perforator flap. An ultrasoundguided perforator flap with an aponeurosis plug can be an option for patients suffering from an open abdomen with a bowel fistula.
ABSTRACT
BACKGROUND: Necrotizing fasciitis is a serious infection that originates in the subcutaneous tissues. Although many reports have been published about necrotizing infections of other anatomical sites, retroperitoneal necrotizing soft tissue infection is a rare entity that has been described in only a few case reports. The etiology and clinical course of retroperitoneal necrotizing fasciitis can be variable and it is often difficult to identify the etiology of the infective process. CASE REPORT: We report a 58-year-old man with rapidly progressive, gas-producing, necrotizing inflammation in the retroperitoneum, complicated with genital involvement resembling Fournier gangrene. The patient was managed successfully by aggressive drainage, debridement, and sequential laparotomies to track and control the extensive necrosis of the retroperitoneum and perineum, in addition to systemic care to control sepsis. After his general condition stabilized, early rectosigmoid adenocarcinoma was identified and resected curatively. He remained well at follow up, six months after discharge. RESULTS: In retrospect, the trigger of the disease process was unclear. Although it was believed possibly to be due to the colon lesion, adenocarcinoma of the rectosigmoid colon was identified and the patient was managed successfully. CONCLUSIONS: Similar to necrotizing infections at other anatomical sites, early diagnosis and timely surgical intervention and systemic antimicrobial therapy are mandatory for treating patients with retroperitoneal necrotizing fasciitis.
Subject(s)
Fasciitis, Necrotizing/complications , Fasciitis, Necrotizing/diagnosis , Fournier Gangrene/diagnosis , Genital Diseases, Male/diagnosis , Retroperitoneal Space/pathology , Adenocarcinoma/diagnosis , Adenocarcinoma/surgery , Anti-Bacterial Agents/therapeutic use , Debridement , Drainage , Fasciitis, Necrotizing/pathology , Fasciitis, Necrotizing/therapy , Fournier Gangrene/pathology , Genital Diseases, Male/pathology , Genital Diseases, Male/therapy , Humans , Laparotomy , Male , Middle Aged , Radiography, Abdominal , Rectal Neoplasms/diagnosis , Rectal Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
Gastrointestinal stromal tumors (GISTs) rarely arise in the rectum. Whereas a local resection with negative margins is generally considered adequate for resectable GISTs, a wide resection is usually indicated for rectal lesions because of the technical impossibility of local resection. We report the cases of two patients who underwent resection of a rectal GIST using a transsacral approach. Both patients had an uneventful postoperative course, and no evidence of recurrence has been identified. The transsacral approach appears to be less invasive and should be considered as the treatment of choice for a rectal GIST.
Subject(s)
Colorectal Neoplasms/surgery , Digestive System Surgical Procedures/methods , Gastrointestinal Stromal Tumors/surgery , Treatment Outcome , Aged , Colorectal Neoplasms/pathology , Female , Gastrointestinal Stromal Tumors/pathology , Humans , Male , Middle AgedABSTRACT
Gastric volvulus is an uncommon entity that may rapidly progress to infarction and necrosis of the stomach. We herein report the case of a 67-year-old man with acute gastric volvulus in association with wandering spleen. Following a reduction of the volvulus with a nasogastric tube, laparoscopic gastropexy was performed. Pediatric cases of gastric volvulus and a concurrent wandering spleen have been described, but to the best of our knowledge, no adult cases have previously been reported.
