Possibilities of simultaneous reconstructive and restorative treatment for long-term consequences of abdominal injuries: case report

The damage-control strategy for abdominal injuries in modern armed conflicts involves performing obstructive resections with diversion of intestinal contents, temporary abdominal closure (laparostomy), and subsequent staged relaparotomies. This approach increases the risk of postoperative ventral hernia formation. Objective. To demonstrate the feasibility of a one-stage repair of a functioning colostomy and postoperative ventral hernia in a patient with prior abdominal trauma, using preoperative planning based on computed tomography and three-dimensional modeling of the anterior abdominal wall. Case report. A 29-year-old male (Patient R.) was admitted to the Department of Naval Surgery of the S.M. Kirov Military Medical Academy for restoration of colonic continuity 12 months after a penetrating abdominal injury. On admission, a postoperative ventral hernia was identified. Based on computed tomography data, a three-dimensional model of the anterior abdominal wall was created using 3D Slicer software to assess rectus diastasis, hernia dimensions, and to calculate the rectus-to-defect ratio (RDR), component separation index (CSI), and abdominal cavity volume to determine the optimal hernioplasty technique. A simultaneous procedure was performed: closure of a functioning cecostomy, resection of the ileocecal angle with formation of an isoperistaltic side-to-side ileotransverse anastomosis, followed by retromuscular hernioplasty using a mesh implant according to the Rives—Stoppa technique. The postoperative course was uneventful, with primary wound healing and no abnormalities detected on follow-up CT. Conclusion. Simultaneous repair of a functioning colostomy and postoperative ventral hernia is a safe and technically feasible procedure when preceded by thorough preoperative planning and preparation.