Nabulyato William M, Alsahiem Hebah, Hall Nigel R, Malata Charles M
Departments of Plastic Surgery, University of Cambridge, UK ; Addenbrooke's Hospital Cambridge University Hospital NHS Foundtion Trust.
Eplasty. 2013;13:e13. Epub 2013 Mar 7.
Heterotopic mesenteric ossification is an extremely rare condition, which often follows trauma and is frequently symptomatic. To date, there are no reports in the literature of abdominal compartment syndrome occurring after surgical resection of mesenteric calcification. The present report documents an unusual case of compartment syndrome complicating resection of extensive mesenteric calcification despite abdominal closure with the components-separation technique.
A 48-year-old man undergoing components-separation technique for posttraumatic laparostomy hernia repair (ileostomy reversal and sigmoid stricture correction) was found to have extensive heterotopic mesenteric calcification, which needed resection.
Resection of the mesenteric calcification was complicated by intraoperative hemorrhage and unplanned small bowel resection. Later the patient developed secondary hemorrhage leading to an abdominal compartment syndrome, which was successfully treated by decompression, hemostasis, and Permacol-assisted laparotomy wound closure. The patient remains symptom-free more than 2 years after surgery.
The case herein reported gives an account of the rare occurrence of abdominal compartment syndrome following resection of posttraumatic ectopic mesenteric ossifications. It is highly unusual in that it occurred because of "secondary hemorrhage" and despite abdominal closure with the components-separation technique, which had been undertaken precisely to prevent compartment syndrome with direct closure. It therefore highlights the need for continued clinical vigilance in complex posttraumatic cases.
异位肠系膜骨化是一种极为罕见的病症，常继发于创伤且多伴有症状。迄今为止，文献中尚无关于肠系膜钙化手术切除后发生腹腔间隔室综合征的报道。本报告记录了一例不同寻常的病例，尽管采用了成分分离技术关闭腹腔，但广泛肠系膜钙化切除术后仍并发了间隔室综合征。
一名48岁男性因创伤后剖腹术后切口疝修补术（回肠造口还纳和乙状结肠狭窄矫正）接受成分分离技术治疗，术中发现广泛异位肠系膜钙化，需行切除术。
肠系膜钙化切除术中出现出血并发症及意外小肠切除。随后患者发生继发性出血，导致腹腔间隔室综合征，通过减压、止血及Permacol辅助剖腹伤口闭合成功治疗。患者术后2年多仍无症状。
本文报道的病例描述了创伤后异位肠系膜骨化切除术后罕见的腹腔间隔室综合征发生情况。其不同寻常之处在于，尽管采用了成分分离技术关闭腹腔以预防直接缝合导致的间隔室综合征，但仍因“继发性出血”而发生。因此，这凸显了在复杂创伤后病例中持续临床警惕的必要性。
