title: Chronic pelvic abscedation after completion proctectomy in a rectal stump insufficiency; treatment with gracilis muscle flap following vacuum assisted closure therapy.
abstract: Presacral abscess formation due to rectal stump insufficiency following Hartmann procedure is very rare complication. If the abscess cavity is large, it might delay the reversal of the stoma and will probably result in a devastating future functioning of the neorectum. Moreover, very invasive treatments will be required in order to prevent severe septic complications. We present the case of a 58-year-old man with a past history of Hartmann procedure for a low rectal carcinoma who presented with rectal stump insufficiency and a large presacral abscess. Following extensive debridement and rectal stump resection, a vacuum-assisted closure (VAC) system was applied to the large abscess cavity to facilitate gracilis muscle flap reconstruction and to optimize wound healing. The satisfactory results showed in the present report led us to favor a combination of VAC therapy and a gracilis muscle flap in intrapelvic and perineal reconstruction in the case of large defects associated with high risks of septic complications.
authors.affiliation: Department of General Surgery, BulentEcevit University School of Medicine, Zonguldak, Turkey.
authors.forename: Fatma Ayca
authors.initials: FA
authors.lastname: Gultekin
authors.forename: Bekir Hakan
authors.initials: BH
authors.lastname: Bakkal
authors.forename: Sait
authors.initials: S
authors.lastname: Tayfun
authors.forename: Orhan
authors.initials: O
authors.lastname: Babuccu
authors.forename: Mustafa
authors.initials: M
authors.lastname: Comert
keywords: Insufficiency; Negative-pressure Wound therapy; Pedicled flap; Rectal; Stump
references.citation: Endoscopy. 2008 Mar;40(3):192-9
references.pmid: 18189215
references.citation: Clin Colon Rectal Surg. 2008 Feb;21(1):76-85
references.pmid: 20011400
references.citation: Br J Surg. 1982 Oct;69(10):580-2
references.pmid: 7127036
references.citation: Ann Chir. 1992;46(6):491-6
references.pmid: 1444149
references.citation: Ann Plast Surg. 1997 Jun;38(6):553-62
references.pmid: 9188970
references.citation: Colorectal Dis. 2010 Jun;12(6):555-60
references.pmid: 19341404
references.citation: Surg Endosc. 2009 Jun;23(6):1379-83
references.pmid: 19037698
references.citation: Ann Plast Surg. 1997 Jun;38(6):563-76; discussion 577
references.pmid: 9188971
references.citation: Colorectal Dis. 2010 Jul;12(7 Online):e104-8
references.pmid: 19508536
references.citation: World J Gastroenterol. 2010 Sep 28;16(36):4570-4
references.pmid: 20857528
references.citation: Int J Colorectal Dis. 2006 Oct;21(7):657-60
references.pmid: 16447032
references.citation: Dis Colon Rectum. 2008 Apr;51(4):404-10
references.pmid: 18197452
references.citation: Surg Endosc. 2008 Aug;22(8):1818-25
references.pmid: 18095024