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Abdominal Catastrophe in Crohn's Disease Surgery
Hugo Palma Rios1, André Goulart1, Pedro Leão2
1General Surgery Department, Hospital de Braga, Braga, Portugal.
Wounds : a Compendium of Clinical Research and Practice
|February 7, 2018
Summary
Surgery for Crohn's disease poses risks. This case highlights managing anastomotic dehiscence with negative pressure wound therapy and a multidisciplinary approach for successful outcomes.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Abdominal Surgery
Background:
- Crohn's disease presents surgical challenges due to chronic inflammation.
- Intestinal resection is common for Crohn's-related stenosis.
- Surgical complications increase the risk of poor patient outcomes.
Observation:
- A 50-year-old female with Crohn's disease underwent laparoscopic ileocecal resection.
- The surgery was complicated by anastomotic dehiscence, peritonitis, and multiple perforations.
- An end ileostomy and open abdomen managed with negative pressure wound therapy (NPWT) were required.
Findings:
- Multiple interventions were necessary to seal fistulas and promote granulation.
- The patient was hospitalized for 134 days, with eventual stoma reversal and abdomen closure.
- Subsequent hernia repair with mesh and component separation was performed successfully.
Implications:
- Anastomotic dehiscence can lead to severe abdominal complications.
- NPWT and nutritional support are crucial for managing open abdomens and fistulas.
- Multidisciplinary care is essential for complex cases, including stoma reversal and abdominal wall reconstruction.