LAUSR

Rectus abdominis muscles are supplied mainly by superior and inferior epigastric arteries, forming an arcade between them. The ligation of one of them during a surgical intervention usually has no clinical repercussions. However, when both arteries flow are interrupted, there is another clinical scenario. We describe the case of a 74 years-old woman who was admitted for an elective surgery of fourth recurrence of a midline eventration (M2-5W3 European Hernia Society Classification). We treated using preoperative botulinum toxin and Rives-Stoppa surgical technique. On the second postoperative day, the patient suffered a cardiorespiratory arrest due to a pulmonary embolism, therefore anticoagulation was necessary. After anticoagulation the patient showed severe anemia (Hemoglobin 5 g/dL) and tomography computed scan images revealed a big hematoma of the abdominal wall with active bleeding. Embolization of both epigastric, right mammary and left pectoral arteries was performed by interventional radiologists. After 12 days, the patient showed cutaneous surgical wound dehiscence and serohematic foul-smelling fluid. We detected necrosis of the rectus muscles when we debrided the wound. It was treated with daily cures and vacuum therapy without mesh removal, achieving a progressive closure. After six months of follow-up, there are no signs of recurrence. Ischemia of the rectus muscles is a severe complication after eventroplasty that can be treated with debridament of necrotic muscle and vacuum therapy, without removal of mesh if it is sufficiently extended along the healthy abdominal wall and cover the necrotic defect.