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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

Two NPT are seen; one is abdominal NPT and second one is NPT applied on ostomy.
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Related In: Results  -  Collection


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fig5: Two NPT are seen; one is abdominal NPT and second one is NPT applied on ostomy.

Mentions: At postoperative 18th day, Flexi-Seal and pesser tube were removed from the proximal and distal colonic ends (Figure 3). Posterior parts (mesenteric side) of ostomy opening were sutured to each other to make one opening. This opening was converted to ostomy by inverting skin (Figure 4) Glycerin-impregnated gauze and ostomy paste was used over this ostomy. Two NPT systems were applied; one was standard abdominal NPT; second one was performed on the newly created ostomy. Synchronized negative pressure was applied to both of NPTs (Figure 5) [9]. The second NPT on ostomy place was changed 3-4 times a day. Abdominal NPT was changed at 2–4 days' interval. Three days later, stoma maturation completed and second NPT application was stopped. Stoma bags could be applied.


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)

Two NPT are seen; one is abdominal NPT and second one is NPT applied on ostomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: Two NPT are seen; one is abdominal NPT and second one is NPT applied on ostomy.
Mentions: At postoperative 18th day, Flexi-Seal and pesser tube were removed from the proximal and distal colonic ends (Figure 3). Posterior parts (mesenteric side) of ostomy opening were sutured to each other to make one opening. This opening was converted to ostomy by inverting skin (Figure 4) Glycerin-impregnated gauze and ostomy paste was used over this ostomy. Two NPT systems were applied; one was standard abdominal NPT; second one was performed on the newly created ostomy. Synchronized negative pressure was applied to both of NPTs (Figure 5) [9]. The second NPT on ostomy place was changed 3-4 times a day. Abdominal NPT was changed at 2–4 days' interval. Three days later, stoma maturation completed and second NPT application was stopped. Stoma bags could be applied.

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