Multiple bowel perforation and necrotising fasciitis secondary to abdominal liposuction in a patient with bilateral lumbar hernia

ABSTRACT

We present a rare complication of abdominal liposuction: bowel perforation and necrotizing fasciitis. Because of bilateral lumbar hernia, a 56-year-old woman had caecum and descending colon perforation during lipoplasty. She had septic shock syndrome at her admission. The authors treated this complex wound with several debridement, omental flap, NPWT and split-thickness skin graft. The incidence of abdominal wall perforation with visceral injury is 14 in 100,000 liposuctions performed. There are only 12 cases of bowel perforation in literature but this complication is probably underestimated. Prompt surgical debridement is absolutely mandatory in this life threatening scenario. Lumbar hernia is very rare and should be ruled out before every abdominal liposuction clinically or with imaging modalities.

KEY WORDS

Bowel perforation - liposuction - lumbar hernia - necrotizing fasciitis - negative pressure large wound therapy

• REFERENCES

• 1 Grazer FM. Suction-assisted lipectomy, suction lipectomy, lipolysis, and lipexeresis. Plast Reconstr Surg 1983; 72: 620-3
• 2 Grazer FM, de Jong RH. Fatal outcomes from liposuction: Census survey of cosmetic surgeons. Plast Reconstr Surg 2000; 105: 436-46
• 3 Talmor M, Hoffman LA, Lieberman M. Intestinal perforation after suction lipoplasty: A case report and review of the literature. Ann Plast Surg 1997; 38: 169-72
• 4 Ovrebø KK, Grong K, Vindenes H. Small intestinal perforation and peritonitis after abdominal suction lipoplasty. Ann Plast Surg 1997; 38: 642-4
• 5 Rao RB, Ely SF, Hoffman RS. Deaths related to liposuction. N Engl J Med 1999; 340: 1471-5
• 6 Heitmann C, Czermak C, Germann G. Rapidly fatal necrotizing fasciitis after aesthetic liposuction. Aesthetic Plast Surg 2000; 24: 344-7
• 7 Sharma D, Dalencourt G, Bitterly T, Benotti PN. Small intestinal perforation and necrotizing fasciitis after abdominal liposuction. Aesthetic Plast Surg 2006; 30: 712-6
• 8 Zhou X, Nve JO, Chen G. Lumbar hernia: Clinical analysis of 11 cases. Hernia 2004; 8: 260-3
• 9 Fontoura RD, Araújo ES, Oliveira GA, Sarmenghi Filho D, Kalil M. Spontaneous bilateral Petit hernia. Rev Col Bras Cir 2011; 38: 369-70
• 10 Di Candia M, Malata CM. Aesthetic and functional abdominal wall reconstruction after multiple bowel perforations secondary to liposuction. Aesthetic Plast Surg 2011; 35: 274-7