Bowel perforation after liposuction in abdominal contouring
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Complications following liposuction are rare, but they can be very serious, such as penetration of the abdominal wall and consequent lesion of one or more viscera. Patient position on the operating table and abdominal wall laxity during surgery as well as the timing of each specific procedure played an important role in the occurrence of bowel perforation.

A 69-year-old nonsmoker and not consuming alcohol woman seeking an abdominal profile reshaping procedure. The patient suffered from hypertension and gastroesophageal reflux, both drug-treated. The patient presented an 18-cm long linear scar on the left lateral side of her abdomen due to open kidney surgery performed 30 years before for renal stones removal and she did not complain of any abdominal symptoms at the time of the visit.

At the ultrasound investigation, the bulge revealed a portion of 0,7 cm of relaxed fascia underlying the existing scar with protrusion of fatty tissue through the gap, without any sign of intestinal loop involvement. A double plication of the left external oblique muscle was performed, after drug-induced muscle relaxation. Then liposuction was performed using a 4 mm blunt cannula and about 800cc of clear adipose tissue was removed without bleeding.

A short scar abdominoplasty completed the procedure, removing conventional skin and subcutaneous flap from the hypogastric area, any sign of muscle wall damage was noticed. Overall, surgery time took 95 min, antibiotic and antithrombotic prophylaxis therapies were administered. Abdominal radiography revealed free intraperitoneal air in the right hypochondriac region associated with a minor expansion of the pulmonary basal region on the same side. CT-scan confirmed the presence of free air in the abdomen, ascending colon alterations and showed fluids in the perihepatic area and in the small pelvis.

The postoperative 7 days showed to be regular, gradually the patient started eating until the resolution of postoperative paralytic ileus and a complete canalization was reached. The patient was discharged on the 14th day of hospitalization provided with a diet schedule, drug therapy, and advised to wear a girdle for 3 months. Follow-up didn’t show any sign of further complication.