Surgical Management of Enterocutaneous Fistula in a Patient with a Giant Incisional Hernia: A Case Report.

Abstract

Incisional hernias occur in 3.8–11.5% of patients following abdominal surgery, representing a common postoperative complication. Enterocutaneous fistula (ECF) formation within this patient subset is infrequent yet poses a significant risk, associated with heightened morbidity and mortality rates.

The management of giant incisional hernias (GIH) accompanied by loss of abdominal domain and ECF presents a formidable surgical challenge, often characterized by a high recurrence rate.

The case under consideration involves an obese woman presenting to our emergency department with a 24-year history of incisional hernia. She manifested GIH with loss of domain (LOD) and concomitant ECF, stemming from a prior exploratory laparotomy for peritonitis two decades prior, which was followed by the development of an incisional hernia. Notably, the ECF was characterized by substantial chyme discharge.

The patient underwent a herniotomy and small intestine resection as the initial intervention, with subsequent closure limited to the skin. Six months later, a hernia repair incorporating mesh implantation was performed. However, this procedure was complicated by the development of extensive skin flap necrosis, necessitating management with vacuum therapy.