Palma Rios Hugo, Goulart André, Leão Pedro
General Surgery Department, Hospital de Braga, Braga, Portugal.
General Surgery Department, Hospital de Braga, Braga, Portugal; and Surgical Sciences Research Domain, Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal.
Wounds. 2018 Jan;30(1):E1-E4.
Performing surgery on patients with Crohn's disease is a true challenge due to the elevated risk of complications related to the chronic proinflammatory response. Stenosis is the leading cause of intestinal resection in these patients.
The authors present the case of a 50-year-old woman with inflammatory stenosis of the terminal ileum due to Crohn's disease. The patient underwent a laparoscopic ileocecal resection, which was complicated by a small anastomotic dehiscence with localized peritonitis. Several perforations and dehiscences were observed and necessitated an end ileostomy and an open abdomen treated with negative pressure wound therapy. Multiple surgical interventions in the abdomen were performed and negative pressure was maintained until all fistulas were sealed and granulation tissue formed. Patient was discharged after 134 days of hospitalization with both the abdomen and the ileostomy closed. After several months, a hernia repair was performed with bilateral component separation and polypropylene mesh without complications.
Anastomotic dehiscence after intestinal resection can lead to an abdominal catastrophe. Severe peritonitis with enteric fistulas and an open abdomen demands a multidisciplinary approach. Negative pressure wound therapy and nutritional support are key treatments. In these patients, stoma closure and abdominal wall reconstruction after recovery from the acute event represents another surgical challenge.
由于与慢性促炎反应相关的并发症风险升高，对克罗恩病患者进行手术是一项真正的挑战。狭窄是这些患者肠道切除的主要原因。
作者介绍了一名50岁女性因克罗恩病导致回肠末端炎性狭窄的病例。患者接受了腹腔镜回盲部切除术，术后出现小的吻合口裂开并伴有局限性腹膜炎。观察到多处穿孔和裂开，需要进行末端回肠造口术和采用负压伤口治疗的开放腹腔处理。对腹部进行了多次手术干预，并持续保持负压，直到所有瘘口封闭且形成肉芽组织。患者住院134天后出院，腹部和回肠造口均已闭合。数月后，进行了双侧成分分离和聚丙烯网片修补的疝修补术，未出现并发症。
肠道切除术后吻合口裂开可导致腹部灾难性后果。伴有肠瘘和开放腹腔的严重腹膜炎需要多学科方法处理。负压伤口治疗和营养支持是关键治疗措施。在这些患者中，急性事件恢复后造口关闭和腹壁重建是另一项手术挑战。
