Abstract
A 71-year-old woman with acute abdomen was referred to our hospital. Acute generalized peritonitis and gastrointestinal perforation were diagnosed based on the findings on abdominal examination and computed tomography (CT), and emergency surgery was performed. The peritoneal cavity was found to be contaminated with feces, and a 1-cm-diameter perforation of a diverticulum in the rectosigmoid colon was detected. Widespread ischemia, extending from the small intestine to the cecum, was also evident, and nonocclusive mesenteric ischemia was diagnosed. Hartmann’s procedure was carried out, and thereafter, we adopted open abdominal management to avoid massive resection of the small intestine. The wound was covered using a sterilized, commercially available polyethylene bag, which was sutured circumferentially to the surrounding skin to conclude the operation. Postoperatively, the patient remained on artificial ventilation；on a daily basis, the bottom of the polyethylene bag was freed and the entire small intestine was examined manually. On day 4, we determined that preservation of the intestine was feasible and closed the wound. The patient was discharged on day 41. After surgical procedures, open abdominal management solely by suturing a polyethylene bag is exceptionally simple, as it offers not only a clear view from outside, because the bag is transparent, but also allows repeated manual examinations of the entire intestine. Hence, this is an extremely useful technique.
