Strategic wound and nutritional management for short bowel syndrome and wound dehiscence following non-occlusive mesenteric ischemia: a case report.

INTRODUCTION AND

IMPORTANCE

Non-occlusive mesenteric ischemia (NOMI) is life-threatening and may require extensive bowel resection, resulting in short bowel syndrome (SBS), nutritional deficiencies, and impaired wound healing. Severe wound dehiscence further complicates postoperative management, and reports describing this sequence are limited. This report highlights coordinated, phase-oriented management in an immunocompromised patient.

PRESENTATION OF CASE: An 81-year-old female receiving immunosuppressive therapy underwent emergency Hartmann's procedure for perforated sigmoid diverticulitis. Postoperative septic shock required vasopressor support. On postoperative day (POD) 9, NOMI was diagnosed, necessitating subtotal small bowel resection and total colectomy, leaving approximately 70 cm of jejunum with an end jejunostomy. Extensive wound dehiscence developed by POD 21. Management included debridement, povidone-iodine sugar paste, 4 weeks of negative-pressure wound therapy with instillation, and trafermin. Complete secondary-intention closure without skin grafting was achieved by POD 90. Enteral and oral nutrition were gradually introduced while parenteral support was continued, and the high-output stoma was controlled with antidiarrheal agents and proton-pump inhibitors. The patient was transferred for rehabilitation on POD 120. At 15 months, she remained well, tolerated a regular diet, and required parenteral nutrition only on weekends.

CLINICAL DISCUSSION: Delayed NOMI should be considered after septic shock despite transient hemodynamic stabilization. Phase-oriented wound care, staged nutritional escalation, and stoma output control supported secondary-intention healing without reconstructive surgery in a patient with SBS-related malnutrition.

CONCLUSION

Coordinated wound and nutritional management may enable sustained recovery after NOMI complicated by SBS, high-output stoma, and extensive wound dehiscence.