Enterocutaneous fistula in an incisional hernia

Abstract

Introduction: In the closure of the laparotomy, technical defects such as the use of inadequate sutures, too tight or incorrect distance between stitches, the presence of foreign bodies, hematomas or the inclusion of an intestinal loop (pinching) can cause the appearance of an incisional hernia which, even worse, can be accompanied by an intestinal fistula.

Objective: To corroborate the importance of the correct and careful closure of the abdominal wall after performing laparotomy.

Case presentation: A 34-year-old patient with a history of three previous cesarean sections in a six-year period, the last one performed six months, was treated at the “Mnazi Mmoja” Hospital in Tanzania when she reported the release of a yellowish liquid content at the surgical scar level. Physical examination revealed an incisional hernia and an intestinal loop attached to the skin with a hole of less than one cm through which yellowish intestinal content was coming out. She was operated on with the preoperative diagnosis of incisional hernia and enterocutaneous fistula; a three-cm resection of the ileum, end-to-end anastomosis where the fistulous orifice was located, and hernioplasty were performed using the Rives technique with polypropylene mesh. The postoperative evolution was satisfactory.

Conclusions: The assertion that correct and careful closure of the abdominal wall after laparotomy is of utmost importance, especially if it is performed urgently, is reinforced.