Bowel obstruction secondary to postoperative adhesions
A 52-year old male developed a bowel obstruction secondary to postoperative adhesions. The patient underwent exploratory laparotomy and was primarily closed. That evening he developed increasing respiratory distress and decreased urine output. He was subsequently intubated and on physical exam was found to have an extremely tense abdomen. Bladder pressure was 35mm Hg. Emergent decompressive laparotomy was performed and the Wittmann Patch sewn in to provide temporary closure of his abdomen. He subsequently underwent daily tightenings of the patch. On the eight day he was taken to the operating room, the patch was removed, and the abdominal wall formally closed.
Comment
Use of a device, which accommodated changes in intra-abdominal pressure and allowed simple bedside re-approximation of the fascia on a daily basis, resulted in a primary abdominal closure and avoidance of a hernia and subsequent repairs.
Abdominal compartment syndrome and decompressive laparotomy.
Placement of Wittmann Patch and adjustment to accommodate intra-abdominal pressure.
Tension maintained on fascial edges to prevent retraction and daily adjustments made to re-approximate fascia.
Abdominal wall closure eight days postop.
Case report courtesy of
Martin Schreiber, M.D.
Director of Surgical Critical Care
Trauma and Critical Care Section
Oregon Health & Science University
Portland, OR 97201