Acute Abdomen in the Cosmetic Patient

OBJECTIVE: We present the case of a 51-year-old African American female that underwent abdominoplasty, 360-degree liposuction and fat transfer to bilateral breasts who was subsequently found to have an acute abdomen during her day five post-operative clinic visit. The patient was diagnosed with a nearly ruptured cecum secondary to cecal volvulus and underwent an urgent right hemicolectomy. CASE DESCRIPTION: Our patient is a 51-year-old African American female with a past medical history significant for diabetes mellitus (type II), gastrointestinal reflux disease, generalized anxiety disorder and left breast cancer. Patient had previously undergone left breast lumpectomy with oncoplastic reduction with right breast reduction for symmetry two years prior. She represented with concerns of breast volume loss after radiation but also had cosmetic concerns with respect to her moderate abdominal pannus and excess flank adiposity (Body Mass Index: 38 kg/m2). After obtaining appropriate preoperative medical clearance, the patient presented for an elective abdominoplasty, bilateral fat grafting to breast and 360 degrees liposuction of trunk. Patient was admitted post-operatively for less than 24 hours for routine observation and was discharged on post-operative day one with adequate pain control and mobility. The patient returned to the plastic surgery clinic on post-operative day five for a routine post operative visit. At this time, she was noted to be in respiratory distress, diaphoretic with a near syncopal event and an acute abdomen on examination. Emergency medical services were called, and she was transported to the emergency room. On presentation to the emergency room patient's vitals were significant for a heart rate of 124 beats/minute, blood pressure 130/90 mmHg, respiratory rate 20 breaths per minute and oxygen saturation 98% on room air. Blood investigations were significant for a white blood cell count of 13.3 K/ul, sodium 132 mmol/L and potassium of 3.3 mmol/L. Computed tomography of the abdomen was performed which revealed a dilated cecum to 9cm with mesenteric twisting (whirl sign) concerning for cecal volvulus. A Colorectal surgery consultation was placed, and the patient was resuscitated and taken to the operating room for an upper midline exploratory laparotomy. Intraoperative findings were notable for a significantly dilated cecum with a serosal tear suggesting impending perforation. A right hemicolectomy with ileocolic anastomosis was performed. Post-operatively, the patient was noted to have a prolonged ileus but upon regaining return of bowel function was discharged nine days after surgery. CONCLUSION: There is only one single reported case in the literature similar to ours. We postulate that due to the history of our patient having an increased frequency of narcotic use post operatively combined with an inherently mobile and displaced cecum nay have caused this to occur. Additionally, due to the nature of this procedure, the plication of the rectus abdominis muscles can also cause a decrease in the intra-abdominal volume, possibly fixating the cecum as a result. Therefore, it is important to consider the diagnosis of cecal volvulus or ischemic bowel in patients post abdominoplasty presenting with unspecified abdominal pain not in keeping with a routine course. CORRESPONDING AUTHOR: Deangelo Ferguson, 2799 W Grand Blvd, Detroit, MI, [email protected], 313-806-7555