A rare and life-threatening complication following liposuction

Abstract text (incl. references and figure legends)

Being one of the most popular esthetic procedures, liposuction may have rare yet potentially life-threatening complications. We present a severe case of multiple bowel perforations which resulted in a 5-month long hospitalization, and numerous surgeries – 4 laparotomies, and 13 free skin grafts.

A 43-year-old female patient presented to the ER with severe skin necrosis, covering her entire abdomen and most of her anterior thighs, 5 days after a liposuction procedure which took place as an out-patient procedure in a small private clinic. A CT scan revealed free air in the abdomen, and air and fat stranding in the soft tissue of the abdominal wall and thighs. She was taken to an emergent laparotomy. During surgery multiple enterotomies (perforations) were identified. Also, extensive skin and abdominal wall necrosis, with pockets of pus and enteric content throughout. The entire necrotic fascia and skin were resected, leaving no abdominal wall. In addition, 2 large segments of the small intestines were resected as well. Primary anastomosis were made. Second look surgery took place after 48 hours, with temporary closure of the abdomen with 2 layers of vicryl mesh. During her long stay at the ICU she underwent 2 more laparotomies, and 13 STSG procedures in attempt to restore the resected skin. During the postoperative period the patient developed two enteroatmospheric fistulas. The patient was discharged home after 5 month hospitalization – 3 month of which in the ICU.

A systemic literature review published by Skorochod et al, found 49 cases of abdominal visceral perforation. Seven patients died from this dreadful complication, 20 discharged without any sequelae, and 22 developed complications after discharge.This case of severe skin and fascia necrosis, with multiple small bowel perforations, following liposuction, is extremely rare, in both its severity and the positive intermediate outcome.

Liposuction should be performed in a large hospital with ample experience, close follow up and treating physicians should have a high index of suspicion for complications

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