MANAGEMENT OF SPONTANEOUS ABDOMINAL EVISCERATION tiffany.yu@unlv.edu

PE002

MANAGEMENT OF SPONTANEOUS ABDOMINAL EVISCERATION

3

 

 

 

 

United States

Oral or Poster

This case report describes a 46 year old male who presented to the emergency department for spontaneous bowel evisceration through his prior midline laparotomy incision. The patient had an extensive history of abdominal surgeries, including remote history of exploratory laparotomy and right hemi-colectomy after gunshot injury and subsequent small bowel obstruction which progressed to feculent peritonitis and required multiple operations with a total of ninety centimeters of small bowel resected. The patient had bent over to use the toilet, leading to his spontaneous abdominal evisceration.

Upon presentation to the emergency department, the general surgery team was consulted. The patient was taken to the operating room emergently and found to have five enterotomies involving a single segment of small bowel measuring sixty centimeters, which was resected en-bloc. His bowel appeared viable and was anastomosed at this index case. Given the extensive edema and loss of fascial domain, the abdomen was left open and an Abthera wound vacuum was applied. Patient was taken back to the operating room the following day and successfully underwent abdominal closure with bridging mesh.

Bowel function returned on post-operative day two, and the patient was started on a clear liquid diet. However, due to food aversion and poor oral intake, the patient required a course of total parenteral nutrition. Postoperative course was also complicated by development of intra-abdominal abscess on postoperative day 7 which was managed with intravenous antibiotics.

Prior abdominal surgery can significant weaken abdominal fascia and muscular integrity, significantly increasing risk of bowel evisceration.