Visceral Mobilization Therapy for Gastrointestinal Dysfunction Following Enterocutaneous Fistula Reconstruction: A Case Report.

Abstract

<h4>Introduction</h4>Abdominal surgery is the most common cause of gastrointestinal disorders due to the formation of adhesions in the visceral structures. Few studies have been done in rat models, which revealed that visceral mobilization can effectively prevent adhesion; however, no study has been done on human subjects. The current study was done to provide evidence for future research in this aspect of manual therapy. The objective of the case study was to identify the effectiveness of visceral mobilizations in preventing adhesive bowel disorder.<h4>Case presentation</h4>A 23-year-old male with a height of 164 cm and a weight of 50 kg was admitted to the hospital due to an Enterocutaneous fistula, and surgical correction of ileal perforation was done. The patient underwent abdominal surgery with mesh placement and visceral mobilization post-surgery to reduce the adhesion-related complications.<h4>Clinical discussion</h4>The subsequent development of adherent bowel loops at the umbilical level, accompanied by subcutaneous stranding, indicates significant post-surgical adhesion formation leading to exaggerated gastrointestinal dysfunction. The patient underwent visceral mobilization treatment of the abdomen, followed by breathing exercises from day 1 to day 6 postoperatively. The patient reported notable improvement in gastrointestinal symptoms and constipation, and mild improvement in the quality of life, post-treatment. Follow-up showed significant improvement in Gastrointestinal Symptom Rating Scale (GSRS), Constipation Assessment Scale (CAS), Visual Analogue Scale (VAS), and Gastrointestinal Quality of Life Index (GIQLI) scores.<h4>Conclusion</h4>Visceral mobilization notably improved the gastrointestinal and constipation-related symptoms in early operative days as well as in long-term follow-up, along with improvement of health-related quality of life.<h4>Keywords</h4>abdominal surgery, visceral mobilization, quality of life, case report, enterocutaneous fistula, abdominal adhesions, post-operative rehabilitation, gastrointestinal dysfunction.