Presentation
Postoperative day 4 after radical cystoprostatectomy with ileal conduit. Exquisite generalized abdominal tenderness to palpation.
Patient Data
Noncontrast CT of the abdomen and pelvis demonstrates a large anterior abdominal wall hernia containing fat and bowel, concerning for dehiscence in a postsurgical patient. There is 2.9 cm of diastasis between the rectus muscles, and the total hernia measures 11.4 x 7.0 x 7.3 cm. Apparent interval radical cystectomy, radical prostatectomy, and ileoureteral conduit creation is noted with soft tissue swelling about the surgical sites. Drain tube present.
Other Findings: There is mildly prominent pericardial fat as well as a prominent area of atelectasis/consolidation in the left lower lobe. A stable diaphragmatic pleural-based nodule is present in the right lower lobe. Mildly nodular appearance of the liver with perihepatic ascites. Degenerative changes of the spine, especially at the L5-S1 level.
Case Discussion
A CT was obtained in this patient to rule out an ileal conduit leak after he had surgery for urothelial carcinoma that involved a radical cystoprostatectomy. Poor perfusion due to the patient’s comorbidities led to impaired wound healing and deep dehiscence. Dehiscence of the fascia is a surgical emergency and must be immediately repaired to prevent evisceration. Superficial dehiscence, on the other hand, can usually be treated with abdominal binders to reduce strain on the wound. Increased risk factors for abdominal wound dehiscence include increased age, malnutrition, malignancy, anemia, and infection1.
Case contributors:
- Cecile Swift
- Samuel Patterson, MD
- Gregory Henkle, MD
- Joseph Judge, MD