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Arch Hand Microsurg > Volume 26(1); 2017 > Article
Archives of Hand and Microsurgery 2017;26(1):18-22.
Published online May 30, 2017.
DOI: https://doi.org/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
Seong Hoon Park, Joo Hyun Kim, In Suck Suh, Kwang Yong Kim1, and Hii Sun Jeong*
1Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea. hiisunj@gmail.com
2Department of General Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Received: 29 April 2017   • Accepted: 29 April 2017
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.

Key Words: Disabled persons, Constipation, Aged, Diabetes complications
 


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