AORTIC VASCULAR PROSTHESIS IN ILEOSTOMY RESCUE - PREVENTING REINTERVENTION IN COMPROMISED ABDOMEN: A CASE REPORT

Case Presentation MRHM, 62 years old, female, underwent right colectomy and primary anastomosis in August 2023 due to a colon lesion. She developed an anastomotic fistula on the 7th postoperative day, requiring reoperation and creation of a terminal ileostomy and mucous fistula. In September 2023, an exploratory laparotomy was performed due to an intra-abdominal abscess, resulting in a new ileostomy and closure of the mucous fistula. She was transferred to a university hospital in October 2023 for the treatment of persistent abdominal collection, peristomal dermatitis, and infection of surgical wounds. The collection was resolved by radiological intervention; however, the patient progressed with partial collapse of the ileostomy, leading to subcutaneous contamination and a fistula to the surgical wound. An exceptional measure was adopted by attaching an aortic vascular prosthesis to the ileostomy to extend its length and reduce subcutaneous contamination. After 8 days of hospitalization, there was significant improvement, and the patient was discharged. Follow-up showed complete wound healing and resolution of dermatitis. In November 2023, the prosthesis was removed, revealing a flat ileostomy, well-fixed to the skin. MRHM is being followed by the proctology team.

Discussion The creation of ileostomies, although common, can present significant complication rates. Generally performed in complex surgeries or reoperations, various complications are associated with it, with risk factors including tensioned tissues, poor vascularization, and improper positioning, as well as factors such as obesity and patient malnutrition. These complications directly affect survival and quality of life due to infections, dermatitis, pain, difficulty in pouch attachment, prolonged hospitalizations, and others. Even with necessary care, complications may occur, requiring creative management by the surgeon. In the case presented, an uncommon technique proved highly effective, accelerating peristomal healing, reducing local infection, and significantly improving the patient’s quality of life, with reduced pain and pouch change frequency, which was also reflected in her clinical and laboratory improvement.

Final Considerations In selected and complex cases of retraction and collapse of stomas, the implementation of a vascular prosthesis can be an interesting alternative measure to optimize pouch attachment and reduce contamination and local dermatitis.

 

MissingLinkText

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025