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Accidental peritoneum-cutaneous fistula after insufflation of preoperative progressive pneumoperitoneum in a large incisional hernia with loss of domain
  1. Pablo Guerrero-Antolino,
  2. Salvador Pous-Serrano,
  3. Jose Bueno-Lledo and
  4. Antonio Torregrosa-Gallud
  1. General Surgery, Hospital La Fe, Valencia, Comunidad Valenciana, Spain
  1. Correspondence to Dr Pablo Guerrero-Antolino; pab.guerrero11{at}


Preoperative progressive pneumoperitoneum has represented an important advancement in achieving the reintroduction of large herniated volumes into the abdominal cavity. However, this technique is not free of complications. We present a case of a man in his 70s with an accidental peritoneal-cutaneous fistula, secondary to the excessive pressure of the pneumoperitoneum, during the preparation of a large incisional hernia with loss of domain intervention.

  • General surgery
  • Botulinum toxin
  • Healthcare improvement and patient safety

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  • Contributors All authors contributed to the design of this case report. PG was responsible for collecting baseline data on the patient and establishing a temporal continuity of the entire episode, as well as conducting a literature review on the subject. Both AT-G and JBL were the surgeons responsible for the patient’s intervention and provided information about the patient’s preoperative preparation as well as the surgical approach chosen and the reasoning behind the decision. Both drafted and reviewed the case. The technical components of the case were drafted and reviewed by SP-S, who also provided the iconography. All authors have read, refined and approved the final manuscript. As collaborators, is important to highlight the participation of Providencia García-Pastor, Santiago Bonafé-Diana and Victoria Pareja-Ibars as scientific advisors. Alongside the authors, they designed the protocol for complex incisional hernias with loss of domain.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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