Melnik Idit, Goldstein Dimitry, Yoffe Boris
Department of General and Vascular Surgery, Barzilai Medical Center, Hahistadrout St 2, Ashkelon, 78278, Israel.
J Med Case Rep. 2015 Apr 29;9:95. doi: 10.1186/s13256-015-0569-9.
Repair of contaminated abdominal wall defect in a geriatric patient is a challenge for the surgeon. We present the case of the oldest patient (105-years old) to successfully undergo a single-stage repair of a contaminated abdominal wall defect with a Permacol™ implant.
A 105-year-old Caucasian woman presented to our emergency room with a clinical and radiological diagnosis of small bowel obstruction due to prior operative adhesions. She underwent laparotomy with small bowel resection and primary closure of her abdomen. There was total eventration of her bowel through the suture line 9 days after surgery. She underwent a second laparotomy that revealed no signs of peritonitis or turbid fluid. Her abdomen was closed with a 15 × 10 cm Permacol™ implant sutured sublay with prolene sutures. Her postoperative period was unremarkable. After a follow-up period of 3 years and 2 months, there was no sign of recurrent hernia or wound contamination.
We suggest that Permacol™ mesh can be considered an efficient alternative to primary closure or synthetic mesh in geriatric patients with contaminated abdominal wall defects.
修复老年患者受污染的腹壁缺损对外科医生来说是一项挑战。我们报告了一例年龄最大(105岁)的患者成功使用Permacol™植入物进行单阶段修复受污染腹壁缺损的病例。
一名105岁的白人女性因先前手术粘连导致小肠梗阻,前来我们的急诊室就诊,临床及影像学诊断均为此病。她接受了剖腹手术,进行小肠切除并一期缝合腹部。术后第9天,她的肠管完全通过缝线处脱出。她接受了第二次剖腹手术,未发现腹膜炎或浑浊液体的迹象。她的腹部用一块15×10厘米的Permacol™植入物进行腹膜前修补,用普理灵缝线缝合。她的术后恢复过程顺利。经过3年2个月的随访,没有复发性疝或伤口感染的迹象。
我们建议,对于有受污染腹壁缺损的老年患者,Permacol™补片可被视为一期缝合或合成补片的有效替代方案。