Staged management of a case of traumatic total avulsion of the anterior abdominal wall: A rare case report.
EAES Academy. Ibrahim K. 07/05/22; 363096; P141
Dr. Karim Ibrahim
Contributions
Contributions
Abstract
Mohamed Salama¹, Meraham Ahmed¹, Karim Ibrahim¹, Aya Bessa¹
¹ Damanhour National Medical Institute , El Buheira, Egypt
Abstract
Objective:
Analyzing the stages of surgical management of a patient who sustained a traumatic anterior abdominal wall total avulsion with evisceration of all the abdominal organs.
Background: Significant anterior wall injuries are extremely rare, carrying an estimated prevalence of 0.2-1%. Hence, we are citing this case in which a patient presented with total avulsion of the anterior abdominal wall, with complete evisceration of all the abdominal viscera as well as massive tissue loss, extending from the level of the hypochondrium to the anterior superior iliac spine on both sides. According to the acknowledged grading system of abdominal wall injury, the case was regarded as grade VI (loss of skin, subcutaneous tissues, fascia, and muscles).
Overview: A 39-year-old male patient was brought to our emergency department after he sustained a worksite injury. Upon examination, the patient was shocked with unrecorded blood pressure and total exposure of all abdominal organs. He was resuscitated with pRBCs and plasma and was taken to OR for emergency abdominal exploration. After toilet washes, exploration revealed multiple segments of ischemic bowel loops. Damage control was decided, with resection and ligation of the ischemic segments on two levels; the most proximal was 20 cm from the duodenojejunal junction. At the level of the jejunum, an enterotomy was done with a Foley catheter fixed to the chest wall, and the abdomen was covered with sterile towels. Two days later, a second look took place, in which the edges of the resection sites were trimmed, with secondary anastomoses: side-to-side 70 cm from the DJ junction and end-to-end 1.5 m from the ileocecal valve. Moreover, jejunostomy was done for feeding, and the abdomen was covered by a vicryl mesh to support the abdominal organs and allow the growth of healthy granulation tissues.
Discussion:
Significant abdominal wall injuries are very rare, with only a few publications citing the management of such cases. We are offering our case for open discussion about the best techniques and guidelines to follow upon dealing with such cases.
¹ Damanhour National Medical Institute , El Buheira, Egypt
Abstract
Objective:
Analyzing the stages of surgical management of a patient who sustained a traumatic anterior abdominal wall total avulsion with evisceration of all the abdominal organs.
Background: Significant anterior wall injuries are extremely rare, carrying an estimated prevalence of 0.2-1%. Hence, we are citing this case in which a patient presented with total avulsion of the anterior abdominal wall, with complete evisceration of all the abdominal viscera as well as massive tissue loss, extending from the level of the hypochondrium to the anterior superior iliac spine on both sides. According to the acknowledged grading system of abdominal wall injury, the case was regarded as grade VI (loss of skin, subcutaneous tissues, fascia, and muscles).
Overview: A 39-year-old male patient was brought to our emergency department after he sustained a worksite injury. Upon examination, the patient was shocked with unrecorded blood pressure and total exposure of all abdominal organs. He was resuscitated with pRBCs and plasma and was taken to OR for emergency abdominal exploration. After toilet washes, exploration revealed multiple segments of ischemic bowel loops. Damage control was decided, with resection and ligation of the ischemic segments on two levels; the most proximal was 20 cm from the duodenojejunal junction. At the level of the jejunum, an enterotomy was done with a Foley catheter fixed to the chest wall, and the abdomen was covered with sterile towels. Two days later, a second look took place, in which the edges of the resection sites were trimmed, with secondary anastomoses: side-to-side 70 cm from the DJ junction and end-to-end 1.5 m from the ileocecal valve. Moreover, jejunostomy was done for feeding, and the abdomen was covered by a vicryl mesh to support the abdominal organs and allow the growth of healthy granulation tissues.
Discussion:
Significant abdominal wall injuries are very rare, with only a few publications citing the management of such cases. We are offering our case for open discussion about the best techniques and guidelines to follow upon dealing with such cases.
Mohamed Salama¹, Meraham Ahmed¹, Karim Ibrahim¹, Aya Bessa¹
¹ Damanhour National Medical Institute , El Buheira, Egypt
Abstract
Objective:
Analyzing the stages of surgical management of a patient who sustained a traumatic anterior abdominal wall total avulsion with evisceration of all the abdominal organs.
Background: Significant anterior wall injuries are extremely rare, carrying an estimated prevalence of 0.2-1%. Hence, we are citing this case in which a patient presented with total avulsion of the anterior abdominal wall, with complete evisceration of all the abdominal viscera as well as massive tissue loss, extending from the level of the hypochondrium to the anterior superior iliac spine on both sides. According to the acknowledged grading system of abdominal wall injury, the case was regarded as grade VI (loss of skin, subcutaneous tissues, fascia, and muscles).
Overview: A 39-year-old male patient was brought to our emergency department after he sustained a worksite injury. Upon examination, the patient was shocked with unrecorded blood pressure and total exposure of all abdominal organs. He was resuscitated with pRBCs and plasma and was taken to OR for emergency abdominal exploration. After toilet washes, exploration revealed multiple segments of ischemic bowel loops. Damage control was decided, with resection and ligation of the ischemic segments on two levels; the most proximal was 20 cm from the duodenojejunal junction. At the level of the jejunum, an enterotomy was done with a Foley catheter fixed to the chest wall, and the abdomen was covered with sterile towels. Two days later, a second look took place, in which the edges of the resection sites were trimmed, with secondary anastomoses: side-to-side 70 cm from the DJ junction and end-to-end 1.5 m from the ileocecal valve. Moreover, jejunostomy was done for feeding, and the abdomen was covered by a vicryl mesh to support the abdominal organs and allow the growth of healthy granulation tissues.
Discussion:
Significant abdominal wall injuries are very rare, with only a few publications citing the management of such cases. We are offering our case for open discussion about the best techniques and guidelines to follow upon dealing with such cases.
¹ Damanhour National Medical Institute , El Buheira, Egypt
Abstract
Objective:
Analyzing the stages of surgical management of a patient who sustained a traumatic anterior abdominal wall total avulsion with evisceration of all the abdominal organs.
Background: Significant anterior wall injuries are extremely rare, carrying an estimated prevalence of 0.2-1%. Hence, we are citing this case in which a patient presented with total avulsion of the anterior abdominal wall, with complete evisceration of all the abdominal viscera as well as massive tissue loss, extending from the level of the hypochondrium to the anterior superior iliac spine on both sides. According to the acknowledged grading system of abdominal wall injury, the case was regarded as grade VI (loss of skin, subcutaneous tissues, fascia, and muscles).
Overview: A 39-year-old male patient was brought to our emergency department after he sustained a worksite injury. Upon examination, the patient was shocked with unrecorded blood pressure and total exposure of all abdominal organs. He was resuscitated with pRBCs and plasma and was taken to OR for emergency abdominal exploration. After toilet washes, exploration revealed multiple segments of ischemic bowel loops. Damage control was decided, with resection and ligation of the ischemic segments on two levels; the most proximal was 20 cm from the duodenojejunal junction. At the level of the jejunum, an enterotomy was done with a Foley catheter fixed to the chest wall, and the abdomen was covered with sterile towels. Two days later, a second look took place, in which the edges of the resection sites were trimmed, with secondary anastomoses: side-to-side 70 cm from the DJ junction and end-to-end 1.5 m from the ileocecal valve. Moreover, jejunostomy was done for feeding, and the abdomen was covered by a vicryl mesh to support the abdominal organs and allow the growth of healthy granulation tissues.
Discussion:
Significant abdominal wall injuries are very rare, with only a few publications citing the management of such cases. We are offering our case for open discussion about the best techniques and guidelines to follow upon dealing with such cases.
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