Gardener Caterina, Pandis Laura, Grigatti Martina, Vindigni Vincenzo, Bassetto Franco, Brambullo Tito
Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy.
Clinic of Plastic and Reconstructive Surgery, Neuroscience Department, University of Padua, Italy.
Int J Surg Case Rep. 2020;72:5-9. doi: 10.1016/j.ijscr.2020.05.012. Epub 2020 May 21.
Liposuction is one of the most performed procedures in aesthetic plastic surgery worldwide, and its spectrum of applications covers almost all body areas. Systemic or visceral complications following liposuction are rare, but unfortunately, they can be very serious.
We discuss the case of a 69 y.o. woman who underwent abdominal contouring surgery consisting in flank pseudohernia correction, liposuction and short scar abdominoplasty, which was complicated by intestinal perforation. Bowel perforation was suspected on the 3rd day following surgery after a CT-scan and was treated with exploration through a median laparotomy, resection of the perforated bowel and subsequent ileo-ileal anastomosis. The 10 cm-long resected segment of the small intestine presented multiple 2 mm-large holes at the microscopic examination.
We assume that patient position on the operating table and abdominal wall laxity during surgery as well as the timing of each specific procedure played an important role in the occurrence of bowel perforation.
To our knowledge, this is the first case report of an accidental visceral perforation during a combined procedure of flank bulging correction and abdominal liposuction. Overall the increased risk of combined procedures in plastic surgery is linked to increased operative time. In the current case timing of surgery sequence more than operative time itself was relevant in increasing anterior abdominal wall pressure and thus setting the patient at a higher risk of bowel perforation.
抽脂术是全球美容整形手术中实施最为频繁的手术之一，其应用范围几乎覆盖了身体所有部位。抽脂术后的全身或内脏并发症较为罕见，但不幸的是，这些并发症可能非常严重。
我们讨论了一名69岁女性的病例，她接受了腹部塑形手术，包括矫正侧腹假性疝、抽脂术和短瘢痕腹壁成形术，术后出现了肠穿孔并发症。术后第3天，CT扫描后怀疑出现肠穿孔，遂通过正中剖腹探查术进行治疗，切除穿孔肠段并随后进行回肠-回肠吻合术。在显微镜检查中，切除的10厘米长的小肠段出现多个2毫米大的孔洞。
我们认为患者在手术台上的体位、手术过程中腹壁的松弛程度以及每个具体手术步骤的时机在肠穿孔的发生中起到了重要作用。
据我们所知，这是第一例关于在矫正侧腹膨出和腹部抽脂联合手术过程中意外发生内脏穿孔的病例报告。总体而言，整形手术中联合手术风险增加与手术时间延长有关。在本病例中，手术顺序的时机比手术时间本身更能增加前腹壁压力，从而使患者面临更高的肠穿孔风险。
