Hepatic and colonic eventration due to lumbotomy secondary to muscular denervation: A case report

Abstract

Hepatic and colonic eventration secondary to denervation following lumbotomy is a complex complication involving the protrusion of abdominal viscera through a defect in the lateral abdominal wall, caused by the loss of innervation to the abdominal muscles after a lumbotomy. Based on an exhaustive review of the medical literature, three well-documented cases of hepatic eventration secondary to lumbotomy have been identified. This article presents the case of a 50-year-old female patient (body mass index: 28.5 kg/m ² ) who developed hepatic eventration and eventration of the hepatic flexure of the colon, through an area of muscular atony secondary to denervation from a previous lumbotomy. Bacteriologic investigation of the perirenal abscess indicated growth of Escherichia coli . The authors repaired the defect with a muscular plication without mesh placement given the presence of an actively infected surgical field (Centers for Disease Control and Prevention [CDC] wound class IV). At the 6-month follow-up, no clinical or radiographic evidence of recurrence was observed. Although denervation following lumbotomy is common, hepatic and colonic eventrations are rare and remain difficult to manage. Surgical treatment modalities are still not well defined, and there are no precise recommendations, which is likely due to the relative rarity of these cases. The rationale for mesh avoidance in a contaminated/infected field and the evidence supporting staged repair strategies are discussed.