Use of Vacuum-assisted closure in management of open abdominal wound with multiple enterocutaneous fistulae during chemotherapy: A case report.
Use of Vacuum-assisted closure in management of open abdominal wound with multiple enterocutaneous fistulae during chemotherapy: A case report.
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DOI：
10.1016/j.ijscr.2015.11.003
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发表时间：
2015
影响因子：
0.6
通讯作者：
Yano M
中科院分区：
文献类型：
--
作者：
Fujino S;Miyoshi N;Ohue M;Noura S;Fukata T;Yagi T;Fujiwara Y;Yano M
在患者中观察到多处胃肠道穿孔。患者接受贝伐珠单抗治疗结肠癌复发。胃肠道穿孔是贝伐单抗的致死性不良事件之一。伤口处理以靶向分离肠内容物是重要的。创新的VAC使用可以改善营养状况和整体伤口愈合。负压引流辅助闭合（VAC）可用于治疗复杂伤口，因为它可促进肉芽形成。在本报告中，描述了一个成功的案例VAC用于开放性腹部伤口与肠外瘘后，多个肠穿孔化疗。一名73岁男子因严重腹痛入院。4年前，他因升结肠癌接受了手术切除，并接受了贝伐单抗化疗以治疗复发。体格检查和计算机断层扫描显示肠穿孔，并进行了紧急手术。该手术后，发生了其他肠穿孔，导致术后第10天（POD）出现开放性腹部伤口。为了隔离肠内容物并促进肉芽形成，将VAC应用于存在肠外瘘的腹部伤口。在术后第21天开始经口摄入，伤口尺寸变小。此外，造口袋直接连接到最口腔穿孔部位。患者从危及生命的事件中恢复，无严重感染，并于术后第180天被转移至离家近的另一家医院。已知胃肠道穿孔是贝伐珠单抗的致死性不良事件之一。在该病例中，观察到4例胃肠道穿孔。肠内容物的隔离对于伤口愈合很重要，VAC是一种有效的治疗方法，可用于治疗腹部开放性伤口，即使有肠外瘘。创新的真空负压引流用于治疗腹部开放性伤口可以改善患者的营养状况和整体伤口愈合。
Multiple gastrointestinal perforations were observed in the patient. The patient was treated with bevacizumab for the recurrence of colon cancer. Gastrointestinal perforation is one of the fatal adverse events of bevacizumab. Wound management to target isolation of enteric contents is important. Innovative VAC use can improve the nutritional status and overall wound healing. Vacuum-assisted closure (VAC) is useful for treating complex wounds because it promotes granulation. In the present report, a successful case of VAC used for an open abdominal wound with enterocutaneous fistulae after multiple intestinal perforations during chemotherapy is described. A 73-year-old man was admitted to our hospital with severe abdominal pain. He underwent surgical resection for ascending colon cancer 4 years ago and was administered chemotherapy with bevacizumab for recurrence. Physical examination and computed tomography revealed perforation of the intestine, and an emergency operation was performed. Following this procedure, other intestinal perforations occurred, resulting in an open abdominal wound at postoperative day (POD) 10. To isolate enteric contents and promote granulation, VAC was applied to the abdominal wound with enterocutaneous fistulae. Oral intake started at POD 21 and the wound size became smaller. Further, an ostomy bag was directly attached to the most oral perforation site. The patient recovered from life-threatening events without severe infection and was transferred to another hospital close to his home at POD 180. Gastrointestinal perforation is known to be one of the fatal adverse events of bevacizumab. In this case four gastrointestinal perforations were observed. Isolation of enteric contents is important to heal the wound and VAC is an effective therapy for the management of open abdominal wounds even with enterocutaneous fistulae. Innovative VAC use for the management of open abdominal wounds can improve the nutritional status and overall wound healing of the patient.