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Management of Necrotizing Fasciitis and Fecal Peritonitis following Ostomy Necrosis and Detachment by Using NPT and Flexi-Seal.

Yetışır F, Şarer AE, Acar HZ - Case Rep Surg (2015)

Bottom Line: Loop sigmoidostomy was performed.Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS) (ConvaTec) and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT).After source control, delayed abdominal closure was achieved by skin flap approximation.

View Article: PubMed Central - PubMed

Affiliation: General Surgery Department, Atatürk Research and Training Hospital, 06800 Ankara, Turkey.

ABSTRACT
Management of necrotizing fasciitis and severe faecal peritonitis following ostomy in elderly patient with comorbid disease is challenging. We would like to report management of frozen Open Abdomen (OA) with colonic fistula following ostomy necrosis and detachment in an elderly patient with comorbid disease and malignancy. 78-year-old woman with high stage rectum carcinoma was admitted to emergency department and underwent operation for severe peritonitis and sigmoid colonic perforation. Loop sigmoidostomy was performed. At postoperative 15th day, she was transferred to our clinic with necrotizing fasciitis and severe faecal peritonitis due to ostomy necrosis and detachment. Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS) (ConvaTec) and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT). Maturation of ostomy was facilitated by using second NPT on ostomy side. After source control, delayed abdominal closure was achieved by skin flap approximation.

No MeSH data available.


Related in: MedlinePlus

Edematous and fragile bowel with enteric fistula is seen in OA. Communication between ostomy opening and OA. Separation of ostomy from the skin and division of proximal and distal part of sigmoid colon after ostomy necrosis are seen.
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fig1: Edematous and fragile bowel with enteric fistula is seen in OA. Communication between ostomy opening and OA. Separation of ostomy from the skin and division of proximal and distal part of sigmoid colon after ostomy necrosis are seen.

Mentions: At postoperative 15th day, ostomy necrosis was identified and the patient was consulted to our clinic. Her general condition, consciousness, and orientation were not well. She was mechanically ventilated. Her vital parameters were BP: 85/50 mmHg, HR: 120, RR: 28, F: 38°C, and intra-abdominal pressure (IAP): 14 mmHg. She was in septic shock and mild acidosis (Table 1). SOFA score of the patient was 12 and estimated mortality was 50% accordingly. She underwent emergent reoperation. Necrosis all around the ostomy and complete collapse with mucocutaneous detachment of ostomy were seen. Connection was present between the ostomy opening and midline incision with severe fasciitis and fecal peritonitis. Detached proximal and distal sigmoidostomy openings were seen in abdomen deeply (Figure 1). According to new modified Björck classification OA score of the patient was 4 [8]. All intra-abdominal content was irrigated with saline. Since bowel was very edematous and fragile with severe adhesion and short mesentery, these openings of ostomies could not be mobilized. New proximal end transvers colostomy was opened on right side hardly. To redirect colonic effluent to outside, Flexi-Seal was inserted into proximal opening of detached sigmoidostomy and pesser tube was inserted into distal opening. Glycerin-impregnated gauze was used around detached ostomy opening; pesser drainage tube and Flexi-Seal were also used to support segmentation of ostomy side from OA wound (Figure 2). Abdominal NPT was applied to OA. Low dose enteral nutrition was started at postoperative 1st day and increased day by day.


Management of Necrotizing Fasciitis and Fecal Peritonitis following Ostomy Necrosis and Detachment by Using NPT and Flexi-Seal.

Yetışır F, Şarer AE, Acar HZ - Case Rep Surg (2015)

Edematous and fragile bowel with enteric fistula is seen in OA. Communication between ostomy opening and OA. Separation of ostomy from the skin and division of proximal and distal part of sigmoid colon after ostomy necrosis are seen.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4581508&req=5

fig1: Edematous and fragile bowel with enteric fistula is seen in OA. Communication between ostomy opening and OA. Separation of ostomy from the skin and division of proximal and distal part of sigmoid colon after ostomy necrosis are seen.
Mentions: At postoperative 15th day, ostomy necrosis was identified and the patient was consulted to our clinic. Her general condition, consciousness, and orientation were not well. She was mechanically ventilated. Her vital parameters were BP: 85/50 mmHg, HR: 120, RR: 28, F: 38°C, and intra-abdominal pressure (IAP): 14 mmHg. She was in septic shock and mild acidosis (Table 1). SOFA score of the patient was 12 and estimated mortality was 50% accordingly. She underwent emergent reoperation. Necrosis all around the ostomy and complete collapse with mucocutaneous detachment of ostomy were seen. Connection was present between the ostomy opening and midline incision with severe fasciitis and fecal peritonitis. Detached proximal and distal sigmoidostomy openings were seen in abdomen deeply (Figure 1). According to new modified Björck classification OA score of the patient was 4 [8]. All intra-abdominal content was irrigated with saline. Since bowel was very edematous and fragile with severe adhesion and short mesentery, these openings of ostomies could not be mobilized. New proximal end transvers colostomy was opened on right side hardly. To redirect colonic effluent to outside, Flexi-Seal was inserted into proximal opening of detached sigmoidostomy and pesser tube was inserted into distal opening. Glycerin-impregnated gauze was used around detached ostomy opening; pesser drainage tube and Flexi-Seal were also used to support segmentation of ostomy side from OA wound (Figure 2). Abdominal NPT was applied to OA. Low dose enteral nutrition was started at postoperative 1st day and increased day by day.

Bottom Line: Loop sigmoidostomy was performed.Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS) (ConvaTec) and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT).After source control, delayed abdominal closure was achieved by skin flap approximation.

View Article: PubMed Central - PubMed

Affiliation: General Surgery Department, Atatürk Research and Training Hospital, 06800 Ankara, Turkey.

ABSTRACT
Management of necrotizing fasciitis and severe faecal peritonitis following ostomy in elderly patient with comorbid disease is challenging. We would like to report management of frozen Open Abdomen (OA) with colonic fistula following ostomy necrosis and detachment in an elderly patient with comorbid disease and malignancy. 78-year-old woman with high stage rectum carcinoma was admitted to emergency department and underwent operation for severe peritonitis and sigmoid colonic perforation. Loop sigmoidostomy was performed. At postoperative 15th day, she was transferred to our clinic with necrotizing fasciitis and severe faecal peritonitis due to ostomy necrosis and detachment. Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS) (ConvaTec) and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT). Maturation of ostomy was facilitated by using second NPT on ostomy side. After source control, delayed abdominal closure was achieved by skin flap approximation.

No MeSH data available.


Related in: MedlinePlus