We report about a 50 year old male with a massive abdominal wall defect following takedown of multiple enterocutaneous fistula, who underwent staged repair. His past surgical history was notable for multiple ventral hernia repairs after a subtotal colectomy and end ileostomy for Crohn's disease. He developed multiple recurrent enterocutaneous fistula secondary to unstable abdominal wall coverage. Case Description We report about a 50 year old male with a massive abdominal wall defect following takedown of multiple enterocutaneous fistula, who underwent staged repair. His past surgical history was notable for multiple ventral hernia repairs after a subtotal colectomy and end ileostomy for Crohn's disease. He developed multiple recurrent enterocutaneous fistula secondary to unstable abdominal wall coverage. The patient underwent fistula takedown and ileostomy reciting resulting in a 20x27cm fascial defect. The defect was temporarily repaired with Gore-Tex Dual Mesh secured to the fascial edges under tension. The patient underwent serial excision of the central aspect of the mesh every four days. Five staged procedures reduced the fascial defect to a 3cm width. At the final procedure, the Gore-Tex mesh was excised and component separation was performed contralateral to the ileostomy. The primary fascial repair was reinforced with a dual layer of AlloDerm. The patient was discharged home seven days after his final procedure with excellent ileostomy function. At four months follow up there were no wound complications or signs of recurrent hernia or fistula formation (Figure 1).
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