USA 56-year-old man was injured during rodeo training when he fell off a horse, and the horse landed on his abdomen (abdomen, abdomen), causing internal damage. Initial scans showed a small amount of free fluid in the pelvic cavity (Douglas’ pouch, excavatio rectouterina) and bruising of the mesentery (mesenterium), the tissue connecting the intestines. He experienced ongoing lower abdominal pain, which worsened over two days and developed into signs of peritonitis (inflammation of the abdominal lining, peritonitis). A follow-up scan indicated a possible rupture of the colon (colon).
Surgery revealed a tear in the sigmoid colon (colon sigmoideum). The damaged section was removed, the lower part was sealed off, and a colostomy (colostomia) was created to allow waste to exit the body through an abdominal opening.
After surgery, the patient developed a wound hematoma (haematoma) and the surgical site partially reopened. During a second surgery, the hematoma was removed, but significant intestinal swelling (edema, oedema) prevented immediate closure of the abdomen without risking abdominal compartment syndrome (syndroma compartimenti abdominis). The surgical team opted for an open abdomen approach and applied negative pressure wound therapy (NPWT) to manage the wound.
Over several days, the swelling persisted, so a special mesh implant was used for delayed abdominal closure. The mesh, designed to minimize tissue adhesion, was gradually tightened using stitches to slowly bring the abdominal walls together. Drainage tubes were placed to remove excess fluid, and NPWT was applied on top of the mesh to promote healing.
After 14 days, the abdominal walls were fully closed in stages, and the excess mesh was trimmed and secured with non-absorbable stitches. The patient showed no signs of infection, and the colostomy remained functional throughout the recovery process.
