Small Bowel Strangulation after Free TRAM Breast Reconstruction in Post-hysterectomy Patient: A Case Report

전자궁적출술을 시행받은 환자에서 횡복직근 유리피판을 이용한 유방재건술 후 발생한 소장 교액의 증례

  • Kim, Min-Ho (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Jin, Ung-Sik (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Myung, Yu-Jin (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Chang, Hak (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine) ;
  • Minn, Kyung-Won (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine)
  • 김민호 (서울대학교 의과대학 성형외과학교실) ;
  • 진웅식 (서울대학교 의과대학 성형외과학교실) ;
  • 명유진 (서울대학교 의과대학 성형외과학교실) ;
  • 장학 (서울대학교 의과대학 성형외과학교실) ;
  • 민경원 (서울대학교 의과대학 성형외과학교실)
  • Received : 2011.04.27
  • Accepted : 2011.05.31
  • Published : 2011.07.10

Abstract

Purpose: The rectus abdominis myocutaneous flap is currently the most commonly used donor site of immediate and delayed breast reconstruction surgery, for its versatility and ease of handling, as well as sufficient blood supply. Despite many advantages of rectus abdominis flap, morbidity of donor site is considered as inevitable shortcoming. The authors recently faced a devastating complication, small bowel obstruction that led to strangulation, after delayed breast reconstruction with free transverses rectus abdominis myocutaneous (TRAM) flap. And we would like to report it, because abdominal pain after TRAM flap is a common symptom and can be overlooked easily. Methods: A 56-year-old female patient who had history of receiving total abdominal hysterectomy 20 years ago underwent delayed breast reconstruction with TRAM flap transfer. She complained abdominal discomfort and pain from third postoperative day, postoperative small bowel obstruction that arose from strangulated bowel and prompt emergency operation was done. Results: After resection of the strangulated bowel and reanastomosis, quickly her symptoms were relieved, and there were no further problems during her hospital stay. 7 days after her emergency operation she was discharged. Conclusion: In patients with previous abdominal surgical history, prolonged ileus can lead to bowel strangulation, so surgeons should always consider the possibility, and must be aware of abdominal symptoms in patients who receive free TRAM flap operations.

Keywords

References

  1. Holmstrom H: The free abdominoplasty flap and its use in breast reconstruction. An experimental study and clinical case report. Scand J Plast Reconstr Surg 13: 423, 1979 https://doi.org/10.3109/02844317909013092
  2. Edsander-Nord A, Jurell G, Wickman M: Donor-site morbidity after pedicled or free TRAM flap surgery: a prospective and objective study. Plast Reconstr Surg 102: 1508, 1998 https://doi.org/10.1097/00006534-199810000-00025
  3. Minn KY, Han SB, Lee YH, Kim SW: Study on abdominal sequelae after free TRAM flap or rectus abdominis muscular free flap operation. J Korean Soc Plast Reconstr Surg 26: 257, 1999
  4. Godfrey NV, Godfrey PM: Rupture of abdominal fascial fusion lines: an unusual complication of rectus abdominis flap. Plast Reconstr Surg 93: 396, 1994 https://doi.org/10.1097/00006534-199402000-00028
  5. Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A: Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience. Ann Surg 231: 529, 2000 https://doi.org/10.1097/00000658-200004000-00012
  6. Cappell MS, Batke M: Mechanical obstruction of the small bowel and colon. Med Clin North Am 92: 575, 2008 https://doi.org/10.1016/j.mcna.2008.01.003
  7. Jurado M, Bazan A, Alcazar JL, Garcia-Tutor E: Primary vaginal reconstruction at the time of pelvic exenteration for gynecologic cancer: morbidity revisited. Ann Surg Oncol 16: 121, 2009 https://doi.org/10.1245/s10434-008-0171-0