A case report on management of synergistic gangrene following an incisional abdominal hernia repair in an immunocompromised obese patient

International Journal of Surgery Case Reports
N MeraliAbdulzahra Hussain

Abstract

We present a case on conservative management of salvaging the mesh in an immunocompromised morbidly obese patient, who developed a synergistic gangrene infection following a primary open mesh repair of an incisional hernia. Our patient presented with a surgical wound infection, comorbidities were Chronic Lymphoblastic Leukemia (CLL), Body Mass Index (BMI) of 50, hypertension and diet controlled type-2 diabetes. In surgery, wide necrotic wound debridement, early and repetitive wound drainages with the use of a large pore polypropylene mesh and a detailed surgical follow up was required. High dose intravenous broad-spectrum antibiotic treatment and Negative Pressure Wound Therapy (NPWT) was administrated in combination with adopting a multidisciplinary approach was key to our success. Stoppa Re et al. complied a series of 360 ventral hernia mesh repairs reporting an infection rate of 12% that were managed conservatively. However, our selective case is unique within current literature, being the first to illustrate mesh salvage in a morbid obese patient with CLL. Recent modifications in mesh morphology, such as lower density, wide pores, and lighter weight has led to considerable improvements regarding infection avoidance. This ca...Continue Reading

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Citations

Dec 9, 2017·International Braz J Urol : Official Journal of the Brazilian Society of Urology·Nalisson Marques PereiraNaacia Marques Pereira Carvalho
Apr 27, 2019·Frontiers in Surgery·Hakan Kulacoglu, Ferdinand Köckerling

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