Bibliographic Details
| Title: |
Delayed primary fascia closure of Björck grade 4 open abdomen with enteroatmospheric fistulas after repeated surgery for adhesive small bowel obstruction: a case report |
| Authors: |
Yoshimasa Akashi, Koichi Ogawa, Kaoru Sasaki, Jaejeong Kim, Tsuyoshi Enomoto, Katsuji Hisakura, Yusuke Ohara, Yohei Owada, Kazuhiro Takahashi, Osamu Shimomura, Shinji Hashimoto, Mitsuru Sekido, Tatsuya Oda |
| Source: |
BMC Surgery, Vol 21, Iss 1, Pp 1-7 (2021) |
| Publisher Information: |
BMC, 2021. |
| Publication Year: |
2021 |
| Collection: |
LCC:Surgery |
| Subject Terms: |
Open abdomen, Enteroatmospheric fistula, Björck classification, Small bowel obstruction, Case report, Surgery, RD1-811 |
| More Details: |
Abstract 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. |
| Document Type: |
article |
| File Description: |
electronic resource |
| Language: |
English |
| ISSN: |
1471-2482 |
| Relation: |
https://doaj.org/toc/1471-2482 |
| DOI: |
10.1186/s12893-021-01329-6 |
| Access URL: |
https://doaj.org/article/10397b57c8c54efd9b7fe500acee699d |
| Accession Number: |
edsdoj.10397b57c8c54efd9b7fe500acee699d |
| Database: |
Directory of Open Access Journals |
