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Case Reports in Surgery
Volume 2015 (2015), Article ID 231450, 4 pages
http://dx.doi.org/10.1155/2015/231450
Case Report

Management of Necrotizing Fasciitis and Fecal Peritonitis following Ostomy Necrosis and Detachment by Using NPT and Flexi-Seal

1General Surgery Department, Atatürk Research and Training Hospital, 06800 Ankara, Turkey
2Anesthesiology and Reanimation Department, Atatürk Research and Training Hospital, 06800 Ankara, Turkey
3General Surgery Department, Lokman Hekim Private Hospital, 06100 Ankara, Turkey

Received 2 July 2015; Revised 11 August 2015; Accepted 16 August 2015

Academic Editor: Boris Kirshtein

Copyright © 2015 Fahri Yetışır et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Management of necrotizing fasciitis and severe faecal peritonitis following ostomy in elderly patient with comorbid disease is challenging. We would like to report management of frozen Open Abdomen (OA) with colonic fistula following ostomy necrosis and detachment in an elderly patient with comorbid disease and malignancy. 78-year-old woman with high stage rectum carcinoma was admitted to emergency department and underwent operation for severe peritonitis and sigmoid colonic perforation. Loop sigmoidostomy was performed. At postoperative 15th day, she was transferred to our clinic with necrotizing fasciitis and severe faecal peritonitis due to ostomy necrosis and detachment. Enteric effluent was removed from the OA wound by using the Flexi-Seal Fecal Management System (FMS) (ConvaTec) and pesser tube in deeply located colonic fistula in conjunction with Negative Pressure Therapy (NPT). Maturation of ostomy was facilitated by using second NPT on ostomy side. After source control, delayed abdominal closure was achieved by skin flap approximation.