Skin-only closure for surgical closure of the difficult abdomen with massive visceral edema : A case report

Abstract

A 51-year-old woman presented with anemia and cholangitis. Abdominal computed tomography scan was done; the result revealed a periampullary mass and distal obstruction of the common bile duct. Exploratory laparotomy was performed and an unresectable periampullary tumor that invaded the branches of the mesenteric vein was found. Accidentally, intra–abdominal bleeding from the branches of the mesenteric vein occurred during the operation; the bleeding was stopped by suturing. The patient received a large amount of fluids resuscitation and bowel edema also developed so much that the fascia could not be closed. The skin-only closure was performed as an alternative method of abdominal wall closure. Postoperatively, the patient did not develop abdominal compartment syndrome. The patient, however, developed an incisional hernia that was repaired with mesh 10 months after the abdominal closure.