J Korean Surg Soc.  2013 Nov;85(5):240-243.

Abdominal wall defect with large duodenal disruption treated by a free tissue flap with a help of temporary expandable metallic stent

• Park JH
• Hong SK
• Song HY
• Kim EK
• Lee SK
• Jung YJ

Abstract

Abdominal wall defect with large duodenal disruption after penetrating abdominal injury is a rare emergency situation that can result in life-threatening complications. We report on a 64-year-old man who had abdominal wall defect with large duodenal disruption after penetrating abdominal injury. The patient presented with intra-abdominal exsanguinating bleeding, duodenal disruption, and multiple small bowel perforation. The rarity of this complex injury and its initial presentation as a posttraumatic large duodenal disruption with abdominal wall defect warrant its description. The present case indicates that combining a free tissue flap with a covered expandable metallic stent can effectively and successfully repair an abdominal wall defect that is associated with a large duodenal disruption.

Keyword

Stents; Abdominal wall; Duodenum; Abdominal injury; Free tissue flaps

MeSH Terms

Abdominal Injuries
Abdominal Wall*
Duodenum
Emergencies
Free Tissue Flaps*
Hemorrhage
Humans
Middle Aged
Stents*

Figure

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  Fig. 1 (A) The photograph shows a duodenojejunostomy anastomosis disruption with bile-stained fluid (arrows) and an abdominal wall defect. (B) Fistulography through the two holes at the wound site shows disruption of the duodenum at the duodenojejunostomy anastomosis (arrows). (C) Computed tomographic image shows an open wound at the right abdominal wall (arrows).

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  Fig. 2 Photograph of a covered retrievable expandable nitiol stent.

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  Fig. 3 (A) A contrast study with a coil catheter that was performed 107 days after surgery shows good flow of contrast medium through the expanded stent (arrows) without leakage of the contrast medium through the defective duodenum (arrowhead). (B) A photograph shows closure of the abdominal wall defect with a free flap with endoscopic nasobiliary drainage and endoscopic nasopancreatic drainage. (C) A photograph made 168 days after surgery shows the complete closure of the abdominal wall defect. (D) A contrast study performed 234 days after surgery shows good passage of the contrast with a small enterocutaneous fistula (arrowheads). (E) Computed tomographic image shows healing of an abdominal wall defect.

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