PDF(Pubmed)
Abstract：
Introduction: A high risk patient with evisceration underwent to abdominal wall reconstruction without mesh or drains. We present a case of a 62 years-old female patient with a significant medical history of Wilson\'s disease-related hepatopathy Child-Pugh class B classification, sequelae of a stroke, and relevant surgical background including total hysterectomy, oophorectomy, and Hartmann\'s procedure for ovarian neoplasm stage 3. The patient developed a large incisional hernia in the midline incision while undergoing Bevacizumab (Avastin) treatment for clinical oncology. During an attempt at skin closure due to erosion and necrosis, there was progressive deterioration leading to evisceration. We opted for abdominal wall reconstruction by transposing the hernia sac without using mesh and employing hemostatic powder (Arista) to mitigate the risk of bleeding in a high-risk patient due to recent bevacizumab use and hepatopathy. The patient had a favorable postoperative course without any other intervention in abdominal wall. Patient developed worsening hepatic function with the presence of ascites, constipation, and disorientation. On the 6th day postoperative, a tomography was performed, which showed colonic distension without obstructive factors and a slight amount of supra-aponeurotic fluid. The patient was discharged on the 10th day postoperative after improvement of the condition with clinical treatment. The patient has been progressing under outpatient follow-up for 5 months, with a resumption of chemotherapy cycles and no evidence of hernia recurrence. Conclusion: Further studies and long-term follow-up are necessary to evaluate the efficacy and safety of hernia sac transposition as a mesh-free technique and the use of hemostatic powder without drains in high-risk patients. However, our case highlights the potential feasibility of these approaches in carefully selected cases.
摘要：
简介：一名患有内脏脏器的高风险患者接受了无网眼或引流的腹壁重建。我们介绍了一例62岁的女性患者，有显著的Wilson病相关肝病Child-PughB级分类病史，中风的后遗症,和相关的手术背景，包括全子宫切除术，卵巢切除术,和哈特曼手术治疗卵巢肿瘤3期。患者在接受临床肿瘤学贝伐单抗（阿瓦斯汀）治疗时，在中线切口出现了大的切口疝。在因糜烂和坏死而试图闭合皮肤的过程中，逐渐恶化导致内脏。我们选择了腹壁重建，通过在不使用网片的情况下转置疝囊，并使用止血粉（Arista），以减轻由于最近使用贝伐单抗和肝病而导致的高危患者的出血风险。患者术后病程良好，腹壁无任何其他干预。患者随着腹水的存在出现肝功能恶化，便秘,和迷失方向。术后第6天,进行了断层摄影，显示结肠扩张，没有阻塞性因素和少量的膜上液。经临床治疗，病情好转后，患者于术后第10天出院。病人已在门诊随访5个月,恢复化疗周期，没有疝气复发的证据。结论：需要进一步的研究和长期随访，以评估疝囊转位作为无网眼技术以及在高危患者中使用无引流止血粉的有效性和安全性。然而,我们的案例强调了这些方法在精心选择的案例中的潜在可行性。
