Burst Abdomen Complicated By Ileo-Ileal Intussusception In A Post-Myomectomy Nigerian Woman – Report Of A Case

摘要

Background: Burst abdomen is a rare emergency with known attributable causal factors. However, Ileo-ileal intussusception complicating a burst abdomen following a myomectomy has never been reported in the world literature. This paper presents the case of a burst abdomen complicated by ileo-ileal intussusception in a post-myomectomy patient.Case Report: The case of a 32-year old Nigerian woman who had a conventional open myomectomy, developed a burst abdomen coexisting with intussusception is presented.Results: The patient did well after reduction, discharged from hospital after six days and followed-up for one year with no evidence of recurrence.Conclusion: Vigilance on the bowel while working in the pelvic region is recommended. Additionally, predisposing factors to burst abdomen should always be prevented particularly the surgeon’s factors. Introduction Burst abdomen is a rare emergency in surgical practice with known aetiologic factors. Its occurrence is dreaded not only by the patient but also frightening to by-standers alike. On the other hand, intussusception which usually entails telescoping of the proximal part of the intestine into a distal segment, is commoner in children in the lieal region. In children it is usually benign and without a lead point. In adults, the ileo-ileal type is rare Case report A 32-year old Nigerian woman was referred to the surgical unit having developed a complete wound dehiscence with evisceration in the ward while attempting to see-off relatives that came visiting (Figure 1). Prior to this episode, she had a conventional open myomectomy six days earlier. No history of chronic constipation, diarrhea, cough, abdominal distention or use of enemas. She had commenced oral feeds on the third post-myomectomy day and was being scheduled for discharge on the seventh post-operative day when she developed the burst abdomen on the sixth day. Examination revealed an anxious-looking woman, not pale and not dehydrated or febrile. The vital signs were stable. The abdomen showed a complete wound dehiscence with evisceration of the small bowel and omentum (Figure 1). The post-operative notes indicated that the gynecologist closed the fascia with chromic 1 catgut using a continuous suturing technique. The patient had saline-soaked gauze dressing applied over the eviscerated bowel loops and was prepared for immediate closure.