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Chronic Pelvic Abscedation After Completion Proctectomy in a Rectal Stump Insufficiency; Treatment With Gracilis Muscle Flap Following Vacuum Assisted Closure Therapy

대한대장항문학회지 2013년 29권 4호 p.172 ~ 176
 ( Gultekin Fatma Ayca ) - Turkey BulentEcevit University School of Medicine Department of General Surgery

 ( Bakkal Bekir Hakan ) - Turkey BulentEcevit University School of Medicine Department of Radiation Oncology
 ( Tayfun Sait ) - Turkey BulentEcevit University School of Medicine Department of General Surgery
 ( Babuccu Orhan ) - Turkey BulentEcevit University School of Medicine Department of Plastic
 ( Comert Mustafa ) - Turkey BulentEcevit University School of Medicine Department of General Surgery

Abstract


Presacral abscess formation due to rectal stump insufficiency following Hartmann procedure is very rare complication. If the abscess cavity is large, it might delay the reversal of the stoma and will probably result in a devastating future functioning of the neorectum. Moreover, very invasive treatments will be required in order to prevent severe septic complications. We present the case of a 58-year-old man with a past history of Hartmann procedure for a low rectal carcinoma who presented with rectal stump insufficiency and a large presacral abscess. Following extensive debridement and rectal stump resection, a vacuum-assisted closure (VAC) system was applied to the large abscess cavity to facilitate gracilis muscle flap reconstruction and to optimize wound healing. The satisfactory results showed in the present report led us to favor a combination of VAC therapy and a gracilis muscle flap in intrapelvic and perineal reconstruction in the case of large defects associated with high risks of septic complications.

키워드

Rectal; Stump; Insufficiency; Negative-pressure Wound therapy; Pedicled flap
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