{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T03:14:45Z","timestamp":1785554085245,"version":"3.56.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Surg"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>An open abdomen with frozen adherent bowels is classified as grade 4 in Bj\u00f6rck\u2019s open abdomen classification, and skin grafting after wound granulation is a typical closure option. We achieved delayed primary fascia closure for a patient who developed open abdomen with enteroatmospheric fistulas due to severe adherent small bowel obstruction. We present here the details of his management.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Case presentation<\/jats:title>\n                <jats:p>A 52-year-old man suffered acute abdominal pain during a flight and received an emergency laparotomy due to adhesive small bowel obstruction. Repeated laparotomies were required, and later open abdomen and proximal site jejunostomy were selected. After negative pressure wound therapy, he was transferred to our institution. Two enteroatmospheric fistulas emerged on the exposed intestine, and we diagnosed the condition as a Bj\u00f6rck grade 4 open abdomen. After 8 months of wound care and parenteral nutrition, we decided to attempt primary wound closure because the patient required permanent oral restriction and total parenteral nutrition due to short bowel syndrome. A circular incision along the circumference of the exposed bowel allowed us to take a safe approach into the abdominal cavity. We removed the intestinal adhesions completely and resected the bowels, including the fistulas and anastomosed parts. Finally, the abdominal wall defect was reconstructed using the component separation technique, and the patient was discharged without an ostomy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Primary fascia closure for grade 4 open abdomen is hard, but leaving a long interval before radical surgery and applying pertinent wound management may help solve this adverse situation.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12893-021-01329-6","type":"journal-article","created":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T07:04:57Z","timestamp":1630047897000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Delayed primary fascia closure of Bj\u00f6rck grade 4 open abdomen with enteroatmospheric fistulas after repeated surgery for adhesive small bowel obstruction: a case report"],"prefix":"10.1186","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0589-3816","authenticated-orcid":false,"given":"Yoshimasa","family":"Akashi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koichi","family":"Ogawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaoru","family":"Sasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaejeong","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsuyoshi","family":"Enomoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuji","family":"Hisakura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yusuke","family":"Ohara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Owada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Takahashi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osamu","family":"Shimomura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinji","family":"Hashimoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuru","family":"Sekido","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatsuya","family":"Oda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"issue":"1","key":"1329_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13017-018-0163-8","volume":"13","author":"F Coccolini","year":"2018","unstructured":"Coccolini F, Roberts D, Ansaloni L, Ivatury R, Gamberini E, Kluger Y, et al. The open abdomen in trauma and non-trauma patients: WSES guidelines. World J Emerg Surg. 2018;13(1):1\u201316.","journal-title":"World J Emerg Surg"},{"issue":"1","key":"1329_CR2","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1007\/s12262-015-1422-5","volume":"79","author":"F Yetisir","year":"2017","unstructured":"Yetisir F, Sarer AE, Acar HZ, Aygar M. Delayed closure of 61 open abdomen patients based on an algorithm. Indian J Surg. 2017;79(1):38\u201344.","journal-title":"Indian J Surg"},{"issue":"6","key":"1329_CR3","doi-asserted-by":"publisher","first-page":"1154","DOI":"10.1007\/s00268-009-9996-3","volume":"33","author":"M Bj\u00f6rck","year":"2009","unstructured":"Bj\u00f6rck M, Bruhin A, Cheatham M, Hinck D, Kaplan M, Manca G, et al. Classification-important step to improve management of patients with an open abdomen. World J Surg. 2009;33(6):1154\u20137.","journal-title":"World J Surg"},{"issue":"5","key":"1329_CR4","doi-asserted-by":"publisher","first-page":"809","DOI":"10.1007\/s10029-017-1614-y","volume":"21","author":"F Yetisir","year":"2017","unstructured":"Yetisir F, Sarer AE, Aldan M. New isolation technique for enteroatmospheric fistula in Bj\u00f6rck 4 open abdomen. Hernia. 2017;21(5):809\u201312.","journal-title":"Hernia"},{"issue":"1","key":"1329_CR5","first-page":"80","volume":"25","author":"S E\u011fin","year":"2018","unstructured":"E\u011fin S. Management of enteroatmospheric fistula thanks to new isolation technique. Turk J Trauma Emerg Surg. 2018;25(1):80\u20132.","journal-title":"Turk J Trauma Emerg Surg"},{"issue":"2","key":"1329_CR6","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1007\/s12262-017-1595-1","volume":"79","author":"F Yeti\u015fir","year":"2017","unstructured":"Yeti\u015fir F, Sarer AE. Operative management of enteroatmospheric fistula in Bj\u00f6rck 4 open abdomen patients by the help of laparoscopic lateral approach. Indian J Surg. 2017;79(2):173\u20136.","journal-title":"Indian J Surg"},{"issue":"1","key":"1329_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/S1015-9584(09)60284-0","volume":"29","author":"S Sriussadaporn","year":"2006","unstructured":"Sriussadaporn S, Sriussadaporn S, Kritayakirana K, Pak-Art R. Operative management of small bowel fistulae associated with open abdomen. Asian J Surg. 2006;29(1):1\u20137.","journal-title":"Asian J Surg"},{"issue":"1","key":"1329_CR8","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.suc.2013.10.010","volume":"94","author":"D Demetriades","year":"2014","unstructured":"Demetriades D, Salim A. Management of the open abdomen. Surg Clin North Am. 2014;94(1):131\u201353.","journal-title":"Surg Clin North Am"}],"container-title":["BMC Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01329-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12893-021-01329-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12893-021-01329-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,27]],"date-time":"2021-08-27T07:05:36Z","timestamp":1630047936000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcsurg.biomedcentral.com\/articles\/10.1186\/s12893-021-01329-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,26]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1329"],"URL":"https:\/\/doi.org\/10.1186\/s12893-021-01329-6","relation":{},"ISSN":["1471-2482"],"issn-type":[{"value":"1471-2482","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,26]]},"assertion":[{"value":"16 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was conducted under the approval of the Ethics Committee of Tsukuba University Hospital.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"333"}}