Rectocele is defined as a herniation of the anterior rectal wall through the posterior vaginal wall into the vaginal lumen caused by rectovaginal septum weakness. This entity is more common in postmenopausal female patients. Approximately one-third of adult women affected with pelvic organ prolapse have a significant impact on their quality of life and emotional well-being. Up to more than 90% of woman can be asymptomatic. In symptomatic cases, constipation, defecatory disorders such as obstructed syndrome (ODS) or incontinence, vaginal mass, and pelvic discomfort are the main complaints. Surgical treatment is indicated after failure of conservative management. Talking about ODS, nearly 20% of the patients need surgery. Surgical options can be classified as abdominal (being laparoscopic colposacropexy the technique of choice) or perineal approach. In the latter group, the alternatives are transanal (TA), transperineal (TP), and transvaginal (TV) approaches with or without prosthetic material or grafts. Native-tissue transvaginal approach should be preferentially performed as it has shown better results. Nowadays, there is no consensus on what the gold-standard technique is given the lack of strong evidence.
Aim
Show the benefits of temporary closure with expanded polytetrafluoroethylene (ePTFE) mesh associated with negative pressure therapy (NPT) in the management of catastrophic abdomen.
Material & methods
We present the case of a 74-year-old female who underwent emergency surgery for necrotising fasciitis of the abdominal wall and tertiary peritonitis after a vaginal hysterectomy and anterior colpoplasty, where the use of NPT combined with ePTFE mesh allowed gradual fascial traction until its complete closure (after ten days), restoring the functionality of the abdominal wall.
Results
Temporary abdominal wall closure using NPT with ePTFE mesh allows progressive fascial traction and early closure of the abdominal wall in cases of catastrophic abdomen with low complication rate.
Conclusion
Techniques for temporary abdominal wall closure have led to a significant mortality reduction in cases of complex abdomen. There are several techniques with unclear evidence as to which is optimal. The combined use of NPT with ePTFE mesh is a riveting alternative as it does not adhere to bowel serosa and the risk of eventrations and fistulas are less common.
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