A Novel Method of Intra-Abdominal Cavity Obliteration: A Case Report of a Colonic Seromuscular Flap

Abstract

Summary: Obliteration of an organized subphrenic abscess with an enteric fistula is a great challenge, especially after hepatectomy, as most of the conventional flaps used to fill the abscess cavity are not feasible. A seromuscular flap is an innovative option for this purpose because of its proximity to the pathology, flexibility in the size and volume of the flap harvested, antibacterial ability of the muscle flap, and preservation of trunk musculature. We illustrate the use of a colonic seromuscular flap for filling such an abscess and show its long-term change. A 66-year-old man developed a right subphrenic abscess after subsegmentectomy for his hepatocellular carcinoma. Prolonged percutaneous drainage of the abscess was unsuccessful because of the enteric communication with the transverse colon and resulted only in the organization of the abscess cavity. Through the previous laparotomy incision, the involved part of the transverse colon was detached from the abscess. The transverse colon including the fistula was isolated for 16 cm based on the middle colic vessels. Following an enterotomy along the antimesenteric border and mucosal stripping, a colonic seromuscular flap was made. The debrided abscess cavity was properly filled with this flap. The donor colon was repaired. The postoperative course was uneventful without showing any signs of infection for more than 3 years. During this period, the volume of the flap filling the cavity showed significant reduction of 50%. The seromuscular colonic flap is an effective option for filling the intra-abdominal abscess cavity when most of the conventional flaps are not feasible.