Kunishige Tomohiro, Takayama Tomoyoshi, Matumoto Sohei, Wakatsuki Kohei, Enomoto Koji, Tanaka Tetsuya, Migita Kazuhiro, Kuwahara Masamitsu, Iioka Hiroshi, Nakajima Yoshiyuki
Department of Surgery, Nara Medical University, Nara, Japan.
Int J Surg Case Rep. 2013;4(9):793-7. doi: 10.1016/j.ijscr.2013.05.014. Epub 2013 Jun 29.
In the present paper, we show a rare case of the large abdominal wall defect and enterocutaneous fistulas after the tension free repair using prostheses for incisional hernia.
The patient, a 70-year-old man, had a history of a hemicolectomy for a perforating colon cancer, complicated by a large incisional hernia that was closed primarily but recurred. Three years later, the hernia was repaired at the time of a second colectomy using a Composix Kugel Patch. His course was complicated by a chronic postoperative wound infection with eventual development of enterocutaneous fistulas. The patient was successfully treated with extirpation of the prosthesis, resection of the fistulized bowel, and placement of a tensor fasciae latae myocutaneous flap.
Enterocutaneous fistulas are a known complication of incisional hernia repairs using prostheses. Additional clinical data are required to confirm the safety and efficacy of this procedure as it becomes more widely adopted.
Extirpation of the prosthesis should be performed without delay to prevent serious complications. Reconstruction with a tensor fasciae latae myocutaneous flap was useful for the large abdominal wall defect.
在本文中，我们展示了一例罕见的病例，该患者在使用假体进行切口疝无张力修补术后出现了巨大腹壁缺损和肠皮肤瘘。
患者为一名70岁男性，有因穿孔性结肠癌行半结肠切除术的病史，术后并发巨大切口疝，最初进行了一期缝合，但疝复发。三年后，在第二次结肠切除术时使用Composix Kugel补片对疝进行了修补。其病程因术后慢性伤口感染并最终发展为肠皮肤瘘而复杂化。患者通过假体摘除、瘘管化肠段切除以及阔筋膜张肌肌皮瓣移植成功治愈。
肠皮肤瘘是使用假体进行切口疝修补术的一种已知并发症。随着该手术被更广泛地采用，需要更多临床数据来证实其安全性和有效性。
应立即进行假体摘除以预防严重并发症。使用阔筋膜张肌肌皮瓣进行重建对巨大腹壁缺损有效。
