EP 443 The Role of Bridging Biologic Mesh and Choosing Fascia Over Skin in Hernia Catastrophe: A Case Report
Riem Alkaissy, Vanessa Ziliani, Ioanna Pozotou, Dimitrios Damaskos, Artur Zanellato, Michael HughesAbstract
Aim
To describe the role of damage control surgery in the management of catastrophic abdominal wall hernia presenting with bowel perforation, sepsis and physiological compromise, and to highlight a staged approach prioritizing survival and tissue preservation.
Methods
We report the management of a 65-year-old patient presenting critically unwell with abdominal pain and vomiting. CT demonstrated small bowel perforation secondary to an incarcerated incisional hernia. Background of previous abdominal surgery, type 2 diabetes and morbid obesity. A damage control strategy was employed due to severe intra-abdominal contamination and physiological instability, followed by staged re-interventions focused on infection control, bowel protection, and wound management.
Results
Initial damage control laparotomy included resection of 40 cm small bowel and open abdomen management with negative pressure therapy. Subsequent procedures involved end ileostomy formation and limited abdominal wall reconstruction using a bridging biological mesh. Wound failure, ongoing sepsis, and mesh breakdown necessitated multiple returns to theatre for debridement, washout, and vacuum-assisted closure therapy with instillation of saline. Over time, healthy granulation tissue developed, allowing eventual skin closure and later split-thickness skin grafting. The patient was discharged home after a prolonged admission with satisfactory wound healing.
Conclusion
Damage control surgery is essential in hernia catastrophe to prioritize life-saving measures, control sepsis, and preserve abdominal wall tissues. Definitive complex abdominal wall reconstruction should be deferred until the patient is optimized. Early component separation or advanced reconstruction techniques should be avoided in the acute setting to preserve options for future elective repair.