PMC3593338_01
(a) Preoperative appearance showing ileostomy and massive central abdominal hernia with overlying mature split-thickness skin graft. (b) 2-year postoperative appearance following ileostomy reversal and central abdominal closure by components separation (note the improved nutritional status of the patient.)
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F1
Six months later (after maturation of the split-thickness skin graft covering the bowel; Fig 1a), the patient was admitted for formal repair of his large postlaparotomy hernia by components-separation technique with concurrent reversal of his ileostomy and resection of a posttraumatic sigmoid stricture. He was discharged home after successful postoperative rehabilitation and reports no further complications over 2 years later with the cosmetic results as seen in Fig 1B.
(a) NHS hospital admission CT abdomen, note open laparotomy wound and herniating bowel. (b) CT scan 6 months after initial injury shows herniated bowel, retraction of the abdominal musculature and incidental finding of diffuse peritoneal calcifications prior to components separation. (c) Post components separation closure CT, note remnant calcifications. CT indicates computed tomography.
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F2
Preoperative abdominal computed tomographic scans (Figs 2a and 2b) showed marked divarication (diastasis) of the anterior abdominal wall musculature and subcutaneous fat with obvious herniation of the intra-abdominal contents. No foreign bodies were detected; however, a computed tomographic scan prior to components-separation closure detected extensive peritoneal calcification not seen on previous imaging (Fig 2b).
Two main pieces of ossified abdominal cavity soft tissue. One U-shaped measuring 145 x 30 mm and the other spiral shaped shown above side profile (a) and superior view (b), measuring 140 x 75 mm.
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F3
On laparotomy, some sharp, complex mesenteric peritoneal calcifications were encountered which were thought to pose too great a risk to be left in situ (Fig 3).