Complete abdominal wound and anastomotic leak with diffuse peritonitis closure achieved by an abdominal vacuum sealing drainage in a critical ill patient: a case report.
Complete abdominal wound and anastomotic leak with diffuse peritonitis closure achieved by an abdominal vacuum sealing drainage in a critical ill patient: a case report.
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DOI：
10.1186/s12893-018-0375-6
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发表时间：
2018-06-15
期刊：
影响因子：
1.9
通讯作者：
Hirahara N
中科院分区：
文献类型：
--
作者：
Fujii Y;Tajima Y;Kaji S;Kishi T;Miyazaki Y;Taniura T;Hirahara N
负压伤口治疗（NPWT）是一种广泛接受的治疗皮肤、皮下组织、筋膜或肌肉局部感染性伤口的技术。最近，发表了几份描述NPWT治疗各种类型瘘和吻合口漏的有效性的报告。我们在此描述了一名因结肠吻合口瘘和弥漫性腹膜炎而出现腹部开放性伤口的患者，其中腹部真空封闭（AVS）作为改良NPWT可用于治疗该复杂伤口。一位32岁男性因外伤性疝气及回肠绞窄并发回肠及横结肠坏死而入院。他有14年前因自杀未遂而导致颈脊髓损伤的病史，由于颈脊髓损伤，他的下半身瘫痪。患者接受了紧急疝修补术和肠切除术。术后，他出现严重的败血性休克。术后第6天（POD），诊断为结肠吻合口瘘伴弥漫性腹膜炎导致的伤口裂开，但由于颈髓损伤导致难治性重度感染性休克和神经源性休克，患者无法接受再次手术。患者接受了AVS治疗。他逐渐从感染性休克中恢复，吻合口瘘在2个月后愈合。伤口裂开也减少了。患者于术后第112天恢复经口进食，并于术后第190天出院。虽然手术修复是治疗胃肠道穿孔或吻合口瘘引起的弥漫性腹膜炎的最佳方法，但我们的病例表明，即使存在肠吻合口瘘引起的弥漫性腹膜炎，特别是在一般医疗条件差的患者中，AVS联合“常规”引流也是开放性腹部伤口的治疗选择。
Negative pressure wound therapy (NPWT) is a widely accepted technique to treat local infectious wounds of the skin, subcutaneous tissue, fascia, or muscle. Recently, several reports describing the efficacy of NPWT for various types of fistulas and anastomotic leaks have been published. We herein describe a patient with an open abdominal wound due to colonic anastomotic leakage and diffuse peritonitis, in whom abdominal vacuum sealing (AVS) as a modified NPWT was useful for the management of this complex wound. A 32-year-old man was admitted to our hospital with late presenting traumatic diaphragmatic hernia and strangulated ileum complicated by necrosis of the ileum and transverse colon. He had a history of cervical spinal cord injury due to suicide attempt 14 years earlier and, as a result of cervical spinal cord injury, he was paralyzed in the lower body. The patient underwent an urgent hernia repair and bowel resection. Postoperatively, he developed severe septic shock. On postoperative day (POD) 6, wound dehiscence due to colonic anastomotic leakage with diffuse peritonitis was diagnosed, but he was unable to undergo re-operation because of refractory severe septic shock combined with neurogenic shock due to the cervical cord injury. The patient was treated with AVS therapy. He gradually recovered from septic shock, and the anastomotic leakage healed after a 2-month period. The wound dehiscence was also reduced. The patient resumed oral intake on POD 112 and was discharged on POD 190. Although surgical repair would be the best method for the treatment of diffuse peritonitis due to gastrointestinal perforation or anastomotic leakage, our case suggests that AVS with ‘conventional’ drainage is a treatment of choice for open abdominal wounds even in the presence of diffuse peritonitis caused by intestinal anastomotic leakage, especially in patients with poor general medical condition.
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影响因子：
9.6
作者：
Navsaria, PH;Bunting, M;Kahn, D
通讯作者：
Kahn, D
影响因子：
1.5
作者：
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影响因子：
2.7
作者：
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通讯作者：
Egito, EST
DOI：
10.1097/01.ta.0000203588.66012.c4
发表时间：
2006-02-01
影响因子：
--
作者：
Goverman, J;Yelon, JA;Turcinovic, M
通讯作者：
Turcinovic, M
影响因子：
0.6
作者：
Fujino S;Miyoshi N;Ohue M;Noura S;Fukata T;Yagi T;Fujiwara Y;Yano M
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Yano M