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Case Reports in Surgery
Volume 2015, Article ID 293946, 4 pages
http://dx.doi.org/10.1155/2015/293946
Case Report

Management of Septic Open Abdomen in a Morbid Obese Patient with Enteroatmospheric Fistula by Using Standard Abdominal Negative Pressure Therapy in Conjunction with Intrarectal One

1Atatürk Research and Training Hospital, General Surgery Department, Ankara, Turkey
2Atatürk Research and Training Hospital, Anesthesiology and Reanimation Department, Ankara, Turkey
3General Surgery Department, Bozok University, Tokat, Turkey
4Medical Park Private Hospital, General Surgery Department, Ankara, Turkey

Received 28 September 2015; Revised 19 November 2015; Accepted 23 November 2015

Academic Editor: Gabriel Sandblom

Copyright © 2015 Fahri Yetisir 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

Introduction. Management of open abdomen (OA) with enteroatmospheric fistula (EAF) in morbid obese patient with comorbid disease is challenging. We would like to report the management of septic OA in morbid obese patient with EAF which developed after strangulated recurrent giant incisional hernia repair. We would also like to emphasize, in this case, the conversion of EAF to ileostomy by the help of second Negative Pressure Therapy (NPT) on ostomy side, and the chance of new EAF occurrence was reduced with intrarectal NPT. Case Presentation. 62-year-old morbid obese woman became an OA patient with EAF after strangulated recurrent giant hernia. EAF was converted to ostomy with pezzer drain by the help of second NPT on ostomy. Colonic distention was reduced with the third NPT application via rectum. Abdominal reapproximation anchor (ABRA) system was used for delayed abdominal closure. Conclusions. Using the 2nd NPT on ostomy side may help in the maturation of the ostomy created in a difficult condition in an open abdomen. Using the 3rd NPT through rectum may decrease the chance of EAF formation by reducing the pressure difference between intraluminal pressure and extraluminal pressure in hollow viscera.