Praneeth Moka, Vijay Kumar L, Sarath Kumar Reddy A, Sharath Reddy A, Anil Krishna G, Kiranmai Mynampati
A 35 year old gentleman, a citizen of Yemen, had multiple bullet injuries to the right side of his abdomen on 27th February 2022. He was operated in Yemen on the same day. As reported in the operative notes from Yemen; exploratory laparotomy with splenectomy, gastric wall repair, duodenal wall repair, diaphragm repair and transverse loop colostomy were done. Multiple drains were placed in the abdomen to evacuate hematomas and collections. A second look laparotomy was performed on the 10th March 2022, in view of persistent purulent discharge from the drains and also from the midline wound. And on 19th March 2022, the mid line wound was found to have dehisced, leading to further re-exploration and debridement of left diaphragm region, colostomy site and left side chest wound region. Computerised Tomography (CT) of abdomen done on 29th March 2022, in Yemen, revealed minimal amount of fluid in the left subphrenic and peri gastric region. He presented to us in India, on 23rd April 2022, with nonhealing midline abdominal and left chest wounds, with pus discharge. He complained that orally ingested food was coming out immediately from the left side chest wound and from the midline wound in the abdomen, since the time he was allowed oral diet after his initial surgery. Hence, he was placed on total parenteral nutrition (TPN) for most of the time since the first surgery, at the end of February 2022. Despite being on parenteral nutrition, and nil oral intake, the left chest wound continued to produce approximately 150 mL of pus per day, which was compounded by leaky midline wound.
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