Small Bowel Strangulation after Free TRAM Breast Reconstruction in Post-hysterectomy Patient: A Case Report.

Kim, Min Ho; Jin, Ung Sik; Myung, Yujin; Chang, Hak; Minn, Kyung Won

Case Report

Journal of the Korean Society of Plastic and Reconstructive Surgeons 2011;38(4):531-534.
Published online July 1, 2011.

Small Bowel Strangulation after Free TRAM Breast Reconstruction in Post-hysterectomy Patient: A Case Report.

Min Ho Kim, Ung Sik Jin, Yujin Myung, Hak Chang, Kyung Won Minn

Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine, Seoul, Korea. usj1011@snu.ac.kr

Abstract

PURPOSE
The rectus abdominis myocutaneous flap is currently the most commonly used donor site of immediate and delayed breast reconstruction surgery, for its versatility and ease of handling, as well as sufficient blood supply. Despite many advantages of rectus abdominis flap, morbidity of donor site is considered as inevitable shortcoming. The authors recently faced a devastating complication, small bowel obstruction that led to strangulation, after delayed breast reconstruction with free transverses rectus abdominis myocutaneous (TRAM) flap. And we would like to report it, because abdominal pain after TRAM flap is a common symptom and can be overlooked easily. METHODS: A 56-year-old female patient who had history of receiving total abdominal hysterectomy 20 years ago underwent delayed breast reconstruction with TRAM flap transfer. She complained abdominal discomfort and pain from third postoperative day, postoperative small bowel obstruction that arose from strangulated bowel and prompt emergency operation was done.
RESULTS
After resection of the strangulated bowel and reanastomosis, quickly her symptoms were relieved, and there were no further problems during her hospital stay. 7 days after her emergency operation she was discharged.
CONCLUSION
In patients with previous abdominal surgical history, prolonged ileus can lead to bowel strangulation, so surgeons should always consider the possibility, and must be aware of abdominal symptoms in patients who receive free TRAM flap operations.

Keywords: TRAM flap; Breast reconstruction; Strangulation; Complication