Arch Reconstr Microsurg.  2017 May;26(1):18-22. 10.15596/ARMS.2017.26.1.18.

Bowel Perforation Due to Immobilization after Resurfacing Thumb with Anterolateral Thigh Free Flap in an Elderly Diabetic Woman

• Park SH
• Kim JH
• Suh IS
• Kim KY
• Jeong HS

• KMID: 2388299
• DOI: http://doi.org/10.15596/ARMS.2017.26.1.18

Abstract

Inevitable immobilization after surgery on lower extremities can induce chronic constipation. Elderly diabetic women usually express ambiguous gastrointestinal symptoms and signs. We present here a case of panperitonitis developed from severe fecal impaction in an elderly diabetic woman after hand reconstruction using material harvested from the lower extremities. A 68-year-old diabetic female underwent anterolateral thigh free flap and wound revision twice on the left thumb. Three weeks after surgery, she complained about mild abdominal pain though she had daily defecation. Despite encouraging ambulation, her compliance was low. Resection of the sigmoid colon and colostomy were performed after diagnosis with bowel perforation. However, the patient went into septic shock and died with multiorgan failure after the guardians issued a DNR (do not resuscitate) order. For preventing bowel perforation, increased uptake of dietary fiber and early ambulation postoperatively should be encouraged, after even hand surgeries.

Keyword

Disabled persons; Constipation; Aged; Diabetes complications

MeSH Terms

Abdominal Pain
Aged*
Colon, Sigmoid
Colostomy
Compliance
Constipation
Defecation
Diabetes Complications
Diagnosis
Dietary Fiber
Disabled Persons
Early Ambulation
Fecal Impaction
Female
Free Tissue Flaps*
Hand
Humans
Immobilization*
Lower Extremity
Shock, Septic
Thigh*
Thumb*
Walking
Wounds and Injuries