title: Treatment of delayed jejunal perforation after irreducible femoral hernia repair with open abdomen management and delayed abdominal closure with skin flap approximation.
abstract: BACKGROUND
  We show the management of a delayed jejunal perforation, after irreducible femoral hernia operation with the help of negative pressure therapy (NPT) and delayed abdominal closure (DAC) with skin flap approximation in an elderly woman for the first time in the literature.
  
  
  METHODS
  A 76 year-old woman was admitted to the emergency department with irreducible femoral hernia and ileus. After examining the femoral hernia sac and noting the presence of viable intestine within the hernia sac, a femoral hernia repair with mesh was performed. At postoperative day 1 she started to defecate and oral intake was started. The patient was discharged on postoperative day 3. On postoperative day 8, she was re-admitted to the emergency department with septic shock. The patient underwent reoperation. Septic abdomen and delayed perforation from strangulated part of the jejunum were seen. A jejunostomy was opened and patient was treated with open abdomen management and delayed abdominal closure with skin flap. The ostomy was closed 4 months later.
  
  
  CONCLUSIONS
  The exact mechanism of delayed presentation of small bowel perforation remains controversial. Delayed intestinal perforation has rarely been reported after blunt abdominal trauma (BAT), conductive burn injuries of the bowel with cautery, or necrosis of strangulated bowel in a hernia sac. Open abdomen (OA) management is a life-saving and challenging strategy in severe generalized peritonitis.
  
  
  CONCLUSIONS
  Delayed bowel perforation may develop after irreducible femoral hernia surgery. OA management with NPT and DAC with skin flap approximation are optimal treatment modalities for the hemodynamically instable patient.
authors.affiliation: Atatürk Research and Training Hospital, General Surgery Department, Turkey. Electronic address: drfahriyetisir@hotmail.com.
authors.forename: Fahri
authors.initials: F
authors.lastname: Yetişir
authors.affiliation: Atatürk Research and Training Hospital, Anesthesiology and Reanimation Department, Turkey.
authors.forename: A Ebru
authors.initials: AE
authors.lastname: Sarer
authors.affiliation: Lokman Hekim private Hospital, General Surgery Department, Turkey.
authors.forename: Hasan Zafer
authors.initials: HZ
authors.lastname: Acar
authors.affiliation: Atatürk Research and Training Hospital, General Surgery Department, Turkey.
authors.forename: Omer
authors.initials: O
authors.lastname: Yazıcıoglu
authors.affiliation: Atatürk Research and Training Hospital, General Surgery Department, Turkey.
authors.forename: Basar
authors.initials: B
authors.lastname: Basaran
keywords: Delated abdominal closure; Delayed bowel perforation; Femoral hernia; Open abdomen