PMC4701801_01
Abdominal computed tomography (CT) images of an intestinal perforation.. CT image revealed free air (arrows) in the upper space of the abdomen (A) and also in the lower space of the abdomen (B).
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Abdominal computed tomography (CT) revealed perforation of the intestine (Fig. 1), and an emergency operation was performed.
Photograph of the open abdominal wound with intestinal perforation at POD 10.. A drainage tube (arrow) was placed into the small intestine through a perforation site in the second emergency operation.
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However, drainage of enteric contents through the drainage tube was not effective, and the abdominal wound reopened 2 days later (POD 10 after the first operation) (Fig. 2).
Photographs of VAC therapy for open abdominal wound with fistulae.. (A) Open abdominal wound at POD 11. An arrow shows the most oral perforation site, which is the same site showed in Fig. 2. Arrowheads show other perforations. (B) Mepitel one was cut to the shape of the open abdominal wound and a hole was created for the drainage of enteric contents. (C) GranuFoam was also cut to the shape of the open abdominal wound with a hole for drainage of enteric contents. (D) The wound was covered with a film and a VAC connecting tube (arrow) was affixed to it. Controlled negative pressure was then applied and another suction tube (arrowhead) was positioned at the most oral perforation site for the suction of enteric contents at a pressure of 50 mmHg.
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TX, USA) to minimize abdominal wound infection by isolating enteric contents as well as to promote wound granulation. VAC therapy was administered using a VAC system. The entire wound surrounding the fistulae was treated with VAC therapy (Fig. 3).
Photographs of the open abdominal wound on POD 21.. (A) The wound was almost covered with healthy granulation tissue. (B) The ostomy bag was attached to the most oral perforation site instead of the suction tube depicted in Fig. 3D, and suction pressure of 50 mmHg was continued to drain intestinal contents.
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An ostomy bag was attached to the VAC drape at the most oral perforation site of the intestine, and oral intake started on POD 21 (Fig. 4).
Scheme of the skin rotation and photographs of the open abdominal wound on POD 102 and POD 174.. (A) The dark gray closed circle indicates the most oral perforation site and white gray closed circles indicate the other perforation sites. The skin was cut along the dotted line, and two skin flaps (star and rhomboid) were created. The left side skin was cut and rotated (3). (B) Two skin flaps (star and rhomboid) were rotated onto the granulation tissue. (C) Healthy granulation tissue was observed on POD 102 prior to skin rotation. (D) The skin flap adhered to the healthy granulation tissue on POD102.
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A portion of the skin around the most oral perforation site was then cut and rotated to cover the granulation tissue at POD 102, and the wound contracted (Fig. 5).