Fascial closure with transversus abdominis release in a rare case of idiopathic colonic necrosis requiring open abdomen management

Abstract

　Transversus abdominis release (TAR) is increasingly recognized as an effective method for complex abdominal wall reconstruction, especially in contaminated or high-tension settings. We present a rare case where TAR enabled definitive fascial closure after open abdomen management (OAM). A man in his 40s developed colonic necrosis after cardiac surgery and underwent subtotal colectomy. Severe bowel edema made primary closure unachievable, necessitating OAM. At second-look surgery, persistent fascial retraction precluded standard closure techniques. TAR was performed, allowing medialization of the posterior sheath and tension-free closure. The patient was extubated on postoperative day 5 and discharged without complications on day 58. Compared with anterior component separation, TAR minimizes soft tissue trauma, reduces infection risk, and preserves neurovascular structures, making it suitable for fragile postoperative patients. This case demonstrates TAR’s value as a reconstructive strategy in complex abdominal wall closure when conventional methods fail due to fascial tension or edema after OAM.