Background: A case of a wide postoperative infectious seroma after stoma closure combined with an incisional hernia repair is presented. It was successfully treated with sequential combination therapy involving a locally closed-drainage system (LCDS), followed by negative-pressure wound therapy (NPWT).
Cases: The patient was a 59-year-old man who underwent Hartmann's operation for rectal cancer, after which a postoperative incisional hernia developed. Stoma closure and repair of the incisional hernia, which required wide subcutaneous undermining around the midline incision, were performed. At the surgery, a subcutaneous drain was placed for the wide subcutaneous space around the midline incision, and the stoma site was semi-closed with a purse-string suture. After the surgery, a wide infectious seroma developed around the semi-closed stoma closure wound and was difficult to treat.
On postoperative day (POD) 10, therefore, continuous drainage therapy with LCDS was started for the seroma. On POD 17, the subcutaneous space was significantly reduced with the LCDS, which was then followed by NPWT to cure the semi-closed stoma closure wound. The wound was completely healed on POD 30.
Discussion & Conclusion: Sequential combination therapy with LCDS followed by NPWT seems effective and useful for the treatment of a complex wide infectious seroma.
"},{"@language":"ja","@value":"【背景】ストーマ閉鎖創周囲に広範な感染性漿液腫を発症した症例に対して、持続吸引療法から陰圧閉鎖療法へ移行して合併症なく上皮化を得た症例を経験したので報告する。
【症例】59歳男性、C型肝硬変の加療中。直腸癌に対するハルトマン手術後のストーマ閉鎖と腹壁瘢痕ヘルニア修復術を同時に行った。正中創周囲皮下の剥離範囲に皮下ドレーンを留置し、ストーマ閉鎖部は環状縫合の開放創とした。術後、皮下ドレーン留置部位とは別に、ストーマ閉鎖創周囲に広範な感染性漿液腫を生じた。環状縫合部から漿液腫内にドレーンを留置した上で局所持続吸引療法を開始した。ドレーンからの排液が消失した後に、ドレーンを滅菌スポンジに置換してNPWTへと移行したところ、術後30日目に上皮化して治癒した。
【考察と結論】ストーマ閉鎖創に漿液腫を合併した複雑な創部には、持続吸引療法からNPWTへ移行する本療法が有用と考えられ、本症例でも良好な創治癒が得られた。
"}],"abstractLicenseFlag":"disallow"}],"creator":[{"@id":"https://cir.nii.ac.jp/crid/1410855201292409984","@type":"Researcher","foaf:name":[{"@language":"en","@value":"Tachibana Yukiko"},{"@language":"ja","@value":"立花 由紀子"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"九州大学病院 看護部"},{"@language":"en","@value":"Department of Nursing, Kyushu University Hospital"}]},{"@id":"https://cir.nii.ac.jp/crid/1410855201292409985","@type":"Researcher","foaf:name":[{"@language":"en","@value":"Nagayoshi Kinuko"},{"@language":"ja","@value":"永吉 絹子"}],"jpcoar:affiliationName":[{"@language":"ja","@value":"九州大学医学研究院 臨床・腫瘍外科"},{"@language":"en","@value":"Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University"}]}],"publication":{"publicationIdentifier":[{"@type":"PISSN","@value":"18820115"},{"@type":"EISSN","@value":"24343056"}],"prism:publicationName":[{"@language":"ja","@value":"日本ストーマ・排泄リハビリテーション学会誌"},{"@language":"en","@value":"Journal of Japanese Society of Stoma and Continence Rehabilitation"}],"dc:publisher":[{"@language":"en","@value":"Japanese Society of Stoma and Continence Rehabilitation"},{"@language":"ja","@value":"日本ストーマ・排泄リハビリテーション学会"}],"prism:publicationDate":"2022","prism:volume":"38","prism:number":"2","prism:startingPage":"60","prism:endingPage":"67"},"url":[{"@id":"https://search.jamas.or.jp/link/ui/2022225894"}],"availableAt":"2022","foaf:topic":[{"@id":"https://cir.nii.ac.jp/all?q=%E6%84%9F%E6%9F%93%E6%80%A7%E6%BC%BF%E6%B6%B2%E8%85%AB","dc:title":"感染性漿液腫"},{"@id":"https://cir.nii.ac.jp/all?q=%E5%B1%80%E6%89%80%E6%8C%81%E7%B6%9A%E5%90%B8%E5%BC%95%E7%99%82%E6%B3%95","dc:title":"局所持続吸引療法"},{"@id":"https://cir.nii.ac.jp/all?q=%E9%99%B0%E5%9C%A7%E9%96%89%E9%8E%96%E7%99%82%E6%B3%95","dc:title":"陰圧閉鎖療法"},{"@id":"https://cir.nii.ac.jp/all?q=Infectious%20seroma","dc:title":"Infectious seroma"},{"@id":"https://cir.nii.ac.jp/all?q=Locally%20closed-drainage%20system","dc:title":"Locally closed-drainage system"},{"@id":"https://cir.nii.ac.jp/all?q=Negative-pressure%20wound%20therapy","dc:title":"Negative-pressure wound therapy"}],"dataSourceIdentifier":[{"@type":"JALC","@value":"oai:japanlinkcenter.org:2009362464"}]}