PMC7391113_01
Radiological findings: (a) abdominal contrast-enhanced computed tomography (CT) scan showing fluid collection, an air pocket in the subcutaneous fat layer of the abdominal wall, and edematous changes in the intraperitoneal and abdominal wall adipose tissue (arrow); (b) inflammatory changes are observed around the ascending colon (large arrow).
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Abdominal contrast-enhanced computed tomography (CT) showed fluid collection, an air pocket in the subcutaneous fat layer of the abdominal wall, and edematous changes in the adipose tissue in the peritoneum and abdominal wall (Figure 1(a)). Inflammatory changes were observed around the ascending colon (Figure 1(b)).
The initial surgical and histological findings: (a) the surgical findings revealing extensive necrosis of the retroperitoneal fat around the ascending colon where the inflammation is severe; (b) right hemicolectomy specimen. The pathological findings of the resected specimen reveal peritonitis, ischemic changes, and thinning of the wall of the ascending colon with no malignancy (arrow).
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A right hemicolectomy, ileostomy construction, and debridement of necrotic tissues were performed (Figure 2(a)). The pathological findings of the resected specimen revealed peritonitis and ischemic changes, and the ascending colon was noted to be very thin; however, no malignancy was detected. (Figure 2(b)).
The surgical findings at the second operation. (a) Two days after the initial operation, skin discoloration is observed around the right side of the abdomen. (b) Necrotic tissues were debrided from the level of the right abdominal wall to the affected skin and subcutaneous tissue on the right side of the chest wall. (c) The abdominal wall defect. The intestine, inferior vena cava, and right kidney are exposed (arrow).
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Two days following the initial operation, the skin discoloration around the right side of the abdomen reappeared, which indicated widespread necrosis of the abdominal wall fascia (Figure 3(a)). A second operation was performed, and the necrotic tissue was debrided from the level of the right abdominal wall to the damaged skin and subcutaneous tissue on the right side of the chest wall (Figure 3(b)). The intestine, inferior vena cava, and right kidney were exposed (Figure 3(c)).
The use of ABThera. (a) The ABThera System has a different inner layer design and is composed of a polyurethane film-covered central foam structure with six arms. (b) Installation of the ABThera System involved placing the fenestrated plastic dressing with the incorporated polyurethane sponge over the viscera to protect the abdominal contents. (c) A GranuFoam sponge was subsequently placed over the plastic sheet. (d) The abdomen was sealed with an adherent plastic sheet to the skin, and the ABThera System was set to -125 mmHg continuous suction.
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A closure of the wound defect was planned using the ABThera  System to remove exudate and promote wound healing (Figures 4(a)-4(d)).
Photographs of the wound. The size of the open wound with visible granulation tissue was reduced using the ABThera System. (a) Postoperative day (POD) 10. (b) POD 25. (c) POD 30. (d) The abdominal wall defect was covered by a mesh split-thickness skin graft and anterolateral thigh flap.
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The size of the open wound with visible granulation tissue significantly reduced with no complications such as an enteric fistula (Figures 5(a)-5(c)). Finally, the defect in the abdominal wall was covered by a mesh split-thickness skin graft and an anterolateral thigh flap (Figure 5(d)).
The final appearance of the abdomen: (a) frontal view; (b) right lateral view; (c) dorsal side view.
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The patient was discharged 63 days after admission and was regularly followed up at the outpatient department for 6 months without complications (Figure 6).