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Restoring the Abdominal Cavity Space by Intraabdominal and Extraabdominal Tissue Expansion

Marin-Gutzke, Martina M.D., Ph.D.; Mirelis, Elisa M.D.; Sanchez-Olaso, Alberto M.D., Ph.D.; Quijano, Yolanda M.D.; Vicente, Emilio M.D., Ph.D.

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Plastic and Reconstructive Surgery: January 2008 - Volume 121 - Issue 1 - p 359-360
doi: 10.1097/01.prs.0000300303.72029.e2
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Sir:

Disappearance of the abdominal cavity space due to total small bowel resection, besides being extremely rare, is life threatening and requires intestinal transplantation for survival. However, to receive and preserve trans-planted viscera, both sufficient abdominal cavity space and abdominal wall support are needed. The goals of managing such a case include restoring volume in the cavity and achieving muscular and aponeurotic gain in the abdominal wall for tension-free closure.

We report the case of a 27-year-old patient in whom a total small bowel resection due to an abdominal desmoid tumor resulted in the loss of abdominal cavity space. The patient was a candidate for bowel transplantation, and recreation of the cavity space needed to accommodate the transplant was resolved by staged expansion of the abdominal cavity and the contracted abdominal wall using both intracavitary and intramuscular abdominal tissue expanders.1–5 To our knowledge, this is the first attempt at enlargement of the abdominal cavity with tissue expanders in an adult patient.

The patient presented at the transplant unit in January of 2002 with no abdominal cavity space, as confirmed by computed tomographic imaging. The abdominal wall had a midline laparotomy scar, and there was a duodenostomy on the right side of the abdomen. Abdominal cavity contents were the liver, spleen, stomach, and duodenum. The patient was a good candidate for isolated small bowel transplantation, but the lack of space for the new bowel and the contracted abdominal wall made this option impossible. After evaluating the case, we decided to introduce two tissue expanders, a rounded (1000-ml volume) expander in the pelvic region of the abdominal cavity and a rectangular (700-ml volume) expander in a musculofascial pocket in the abdominal wall, both with distant subcutaneous ports. The recreated abdominal cavity was monitored by computed tomographic imaging (Fig. 1). Expansion was completed by March of 2002, and the small bowel transplantation was undertaken in July of 2002. The patient had tolerated the expanders with no major complications for 5 months. Transplantation was performed with no complications. The abdominal cavity created was large enough to accommodate the bowel, and closure of the abdominal wall was achieved without tension. The immediate posttransplant course was successful.

Fig. 1.
Fig. 1.:
Computed tomographic imaging of the recreated abdominal cavity.

At the time of this writing, 10 months after transplantation, our patient was well. The abdominal cavity created by expansion accommodated the transplanted intestine, and the expanded abdominal wall ensured tension-free closure such that the posttransplant course was uneventful. We propose the addition of this simple and low-morbidity technique to the armamentarium of options for abdominal wall and cavity space reconstruction.

Martina Marin-Gutzke, M.D., Ph.D.

Elisa Mirelis, M.D.

Alberto Sanchez-Olaso, M.D., Ph.D.

Department of Plastic Surgery

Yolanda Quijano, M.D.

Emilio Vicente, M.D., Ph.D.

Department of General Surgery

Hospital Ramón y Cajal

Madrid, Spain

REFERENCES

1. Bax, N. M. A., van der Zee, D. C., Pull ter Gunne, A. J., and Rövekamp, M. H. Treatment of giant omphalocele by enlargement of the abdominal cavity with a tissue expander. J. Pediatr. Surg. 28: 1181, 1993.
2. Hobar, P. C., Rohrich, R. J., and Byrd, H. S. Abdominal-wall reconstruction with expanded musculofascial tissue in a posttraumatic defect. Plast. Reconstr. Surg. 94: 379, 1994.
3. Jacobsen, W. M., Pretty, P. M., Bite, U., and Johnson, C. H. Massive abdominal wall hernia reconstruction with expanded external/internal oblique and transversalis musculofascia. Plast. Reconstr. Surg. 100: 326, 1997.
4. Paletta, C. E., Huang, D. B., Dehghan, K., and Kelly, C. The use of tissue expanders in staged abdominal wall reconstruction. Ann. Plast. Surg. 42: 259, 1999.
5. Carlson, G. W., Elwood, E., Losken, A., and Galloway, J. R. The role of tissue expansion in abdominal wall reconstruction. Ann. Plast. Surg. 44: 147, 2000.

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©2008American Society of Plastic Surgeons