Intensive Care for Postoperative Bleeding in a Severely Obese Patient with Abdominal Wall Scar Hernia and Small Bowel Perforation

Abstract

The patient was a 60-year-old female, height, 159 cm ; weight, 100 kg ; body mass index, 40 kg/m². She had undergone mesh repair for an umbilical hernia 9 years ago. She was brought to our hospital with an emergency because of abdominal pain that had not improved since the previous night. Computed tomography revealed a 14×10-cm incarcerated abdominal wall scar hernia with free air near the small intestine, and emergency surgery was performed. Necrosis of the small intestine with a 1-cm perforation was observed, and resection was performed. The hernia was repaired by removing the mesh using the components separation technique. On postoperative days 14 and 18, the patient experienced hemorrhagic shock due to massive subcutaneous bleeding and emergency surgery was performed. The patient was managed with a ventilator, renal failure requiring hemodialysis, and antibiotic-induced agranulocytosis ; however, she was discharged from the hospital on day 77. The patient had a fever prior to rebleeding, which may have been triggered due to infection. Patients with obesity require adequate hemostasis and infection control because of their fragile tissue and extensive dissection.