Negative Pressure Wound Therapy applied to a cholecystoparietal fistula: How to treat a rare complication of a common condition - a case report

2021 ◽  
Vol 8 (1) ◽  
pp. 4-7
Author(s):  
Francesco Calabrese ◽  
Francesco Palmieri ◽  
Giorgio Querini ◽  
Sandro Zonta
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Rare Complication ◽  
Gallbladder Disease ◽  
Gallstone Disease ◽  
Wound Therapy ◽  
Abdominal Wall Abscess ◽  
Skin Loss ◽  
Patient’S Outcome

A cholecystoparietal fistula is an uncommon complication of gallstone disease as a result of neglected gallbladder disease).The subcutaneous abdominal wall abscess, derived from this condition, might be wide and hard to treat, especially in elderly and debilitated patients. The best management of cholecystoparietal fistula depends on its etiology and may require medical, surgical, or endoscopic treatment. Negative Pressure Wound Therapy (NPWT) is a valuable support therapy that can improve the prognosis of the disease and the patient’s outcome. We report the case of an 89-year-old female patient affected by a spontaneous cholecystoparietal fistula with a wide abdominal wall abscess treated by a one-stage surgical approach combined with NPWT over the resulting skin loss.

scholarly journals Successful Use of Negative Pressure Wound Therapy for Abdominal Wall Necrosis Caused by a Perforated Ascending Colon Using the ABThera System

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Kouki Imaoka ◽  
Takuya Yano ◽  
Yasuhiro Choda ◽  
Ko Oshita ◽  
Yuma Tani ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Open Abdomen ◽  
Anterolateral Thigh Flap ◽  
Temporary Abdominal Closure ◽  
Ascending Colon ◽  
Wound Therapy ◽  
Pressure Therapy ◽  
New Device

Background. The practice of leaving the abdomen open after an emergency laparotomy has gained increasing popularity recently. Negative pressure wound therapy (NPWT) is known as an effective technique in the management of an open abdomen (OA). A new device, the ABThera™ Open Abdomen Negative Pressure Therapy System (KCI USA, San Antonio, TX, USA), was specifically designed to achieve a temporary abdominal closure (TAC) in the management of an OA. This study was aimed at presenting a successful experience of treating a case of abdominal wall necrosis caused by a perforated ascending colon using the ABThera System. Case Presentation. A 66-year-old man was admitted to our hospital with complaints of severe pain in the abdomen. On admission, abdominal contrast-enhanced computed tomography (CT) showed fluid collection, an air pocket in the subcutaneous fat layer of the abdominal wall, and edematous changes in the adipose tissue in the peritoneum and abdominal wall. Based on a diagnosis of peritonitis resulting from a perforated ascending colon, emergency surgery was performed. A right hemicolectomy, ileostomy construction, and debridement of the necrotic tissues were performed. However, necrotizing fasciitis rapidly spread; therefore, more necrotic tissue was debrided in a second operation. The abdominal wall defect was left open, and the ABThera System was used in the management of the OA; this device promoted wound healing. A reduction was observed in the size of the open wound with visible granulation tissue. The defect was finally covered with a mesh split-thickness skin graft and anterolateral thigh flap. Conclusions. In the management of a case of a massive wound with infection, it can be of great benefit to treat the wound with NPWT initially to decrease its size. The ABThera System could facilitate early and safe management of an OA by surgeons.

Incisional Negative-Pressure Wound Therapy Versus Conventional Dressings Following Abdominal Wall Reconstruction

2013 ◽  
Vol 71 (4) ◽  
pp. 394-397 ◽  
Author(s):  
Alexandra Condé-Green ◽  
Thomas L. Chung ◽  
Luther H. Holton ◽  
Helen G. Hui-Chou ◽  
Yue Zhu ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Abdominal Wall Reconstruction ◽  
Wound Therapy

scholarly journals Biomechanical Effects of Incisional Negative Wound Pressure Dressing: An Ex Vivo Model Using Human and Porcine Abdominal Walls

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Boris Jansen-Winkeln ◽  
Stefan Niebisch ◽  
Uwe Scheuermann ◽  
Ines Gockel ◽  
Matthias Mehdorn
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
High Pressures ◽  
Ex Vivo ◽  
Wound Care ◽  
Balloon Catheter ◽  
Ex Vivo Model ◽  
Wound Therapy ◽  
High Resolution Manometry

Introduction. Incisional negative pressure wound therapy (iNPWT) has been of recent interest in different surgical fields as beneficial outcomes on high-risk wounds have been reported. Nevertheless, its mechanisms of function are not widely studied to date. Methods. We established two ex vivo setups of iNPWT in porcine and human abdominal wall for measuring pressures within the wound which result from iNPWT application. For pressure measurements, a high-resolution manometry catheter and a balloon catheter probe were used in a wound sealed with either a commercially available PREVENA VAC kit or a self-made iNPWT kit. Furthermore, we evaluated seroma evacuation by iNPWT. Results. Both setups showed similar characteristics of pressure curves within the wound when applying increasing negative pressures. Application of high pressures did not result in a similar increase in wound pressure. Only subtotal evacuation of seroma by iNPWT application (about 75% of volume) could be detected. Conclusion. Our ex vivo model of iNPWT in porcine and human abdominal wall could show reproducible measurements of pressures within the wounds in both types of tissue. As intrawound pressures did not increase in the same way as the applied negative pressure, we suggest that our results do not advocate the idea of using iNPWT for wound care especially as seroma evacuation remains insufficient.

scholarly journals Closed incision prophylactic negative pressure wound therapy in patients undergoing major complex abdominal wall repair

Hernia ◽  
2017 ◽  
Vol 21 (4) ◽  
pp. 583-589 ◽  
Author(s):  
F. E. E. de Vries ◽  
J. J. Atema ◽  
O. Lapid ◽  
M. C. Obdeijn ◽  
M. A. Boermeester
Keyword(s):  
Abdominal Wall ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Therapy ◽  
Abdominal Wall Repair

scholarly journals Matching Biological Mesh and Negative Pressure Wound Therapy in Reconstructing an Open Abdomen Defect

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Fabio Caviggioli ◽  
Francesco Maria Klinger ◽  
Andrea Lisa ◽  
Luca Maione ◽  
Davide Forcellini ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Skin Graft ◽  
Granulation Tissue ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Rectal Adenocarcinoma ◽  
Biological Mesh ◽  
Split Thickness Skin Graft ◽  
Wound Therapy ◽  
Thickness Skin

Reconstruction of open abdominal defects is a clinical problem which general and plastic surgeons have to address in cooperation. We report the case of a 66-year-old man who presented an abdominal dehiscence after multiple laparotomies for a sigmoid-rectal adenocarcinoma that infiltrated into the abdominal wall, subsequently complicated by peritonitis and enteric fistula. A cutaneous dehiscence and an incontinent abdominal wall resulted after the last surgery. The abdominal wall was reconstructed using a biological porcine cross-linked mesh Permacol (Covidien Inc., Norwalk, CT). Negative Pressure Wound Therapy (NPWT), instead, was used on the mesh in order to reduce wound dimensions, promote granulation tissue formation, and obtain secondary closure of cutaneous dehiscence which was finally achieved with a split-thickness skin graft. Biological mesh behaved like a scaffold for the granulation tissue that was stimulated by the negative pressure. The biological mesh was rapidly integrated in the abdominal wall restoring abdominal wall continence, while the small dehiscence, still present in the central area, was subsequently covered with a split-thickness skin graft. The combination of these different procedures led us to solve this complicated case obtaining complete wound closure after less than 2 months.

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