Chulalongkorn Medical Journal


A 51-year-old woman presented with anemia and cholangitis. Abdominal computedtomography scan was done; the result revealed a periampullary mass and distal obstructionof the common bile duct. Exploratory laparotomy was performed and an unresectableperiampullary tumor that invaded the branches of the mesenteric vein was found. Accidentally,intra–abdominal bleeding from the branches of the mesenteric vein occurred during theoperation; the bleeding was stopped by suturing. The patient received a large amount offluids resuscitation and bowel edema also developed so much that the fascia could not beclosed. The skin-only closure was performed as an alternative method of abdominal wallclosure. Postoperatively, the patient did not develop abdominal compartment syndrome. Thepatient, however, developed an incisional hernia that was repaired with mesh 10 months afterthe abdominal closure.


Faculty of Medicine, Chulalongkorn University

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