Damage Control Surgery for Severe Abdominal Sepsis With Free Skin Graft Transplantation: A Case Report

AbstractOver the past few years, the open abdomen (OA) as a part of Damage Control Surgery (DCS) has been introduced as a surgical strategy with the intent to reduce the mortality of patients with severe abdominal sepsis. Aims of our study were to analyze the OA effects on patients with abdominal sepsis and identify predictive factors of mortality. Patients admitted to our institution with abdominal sepsis requiring OA from 2010 to 2019 were retrospectively analyzed. Primary outcomes were mortality, morbidity and definitive fascial closure (DFC). Comparison between groups was made via univariate and multivariate analyses. On 1474 patients operated for abdominal sepsis, 113 (7.6%) underwent OA. Male gender accounted for 52.2% of cases. Mean age was 68.1 ± 14.3 years. ASA score was > 2 in 87.9%. Mean BMI, APACHE II score and Mannheim Peritonitis Index were 26.4 ± 4.9, 15.3 ± 6.3, and 22.6 ± 7.3, respectively. A negative pressure wound system technique was used in 47% of the cases. Overall, mortality was 43.4%, morbidity 76.6%, and DFC rate was 97.8%. Entero-atmospheric fistula rate was 2.2%. At multivariate analysis, APACHE II score (OR 1.18; 95% CI 1.05–1.32; p = 0.005), Frailty Clinical Scale (OR 4.66; 95% CI 3.19–6.12; p < 0.0001) and ASA grade IV (OR 7.86; 95% CI 2.18–28.27; p = 0.002) were significantly associated with mortality. OA seems to be a safe and reliable treatment for critically ill patients with severe abdominal sepsis. Nonetheless, in these patients, co-morbidity and organ failure remain the major obstacles to a better prognosis.

Download Full-text

Damage control surgery for spontaneous perforation of pyometra with septic shock: a case report

Acute Medicine & Surgery ◽

10.1002/ams2.657 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Ryo Matsumoto ◽

Shunsuke Kuramoto ◽

Tomohiro Muronoi ◽

Kazuyuki Oka ◽

Yoshihide Shimojyo ◽

...

Keyword(s):

Septic Shock ◽

Case Report ◽

Damage Control ◽

Damage Control Surgery ◽

Spontaneous Perforation

Download Full-text

Case report: An unusual presentation of renal hypertension after damage control surgery

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.105872 ◽

2021 ◽

Vol 82 ◽

pp. 105872

Author(s):

Peter Galos ◽

Michael Hultström ◽

Angeliki Dimopoulou Creusen ◽

Gösta Eggertsen ◽

Jozef Urdzik ◽

...

Keyword(s):

Case Report ◽

Damage Control ◽

Renal Hypertension ◽

Damage Control Surgery ◽

Unusual Presentation

Download Full-text

Experience of the MALA Bag in the Open Abdomen Management in an Obstetrical Intensive Care Unit

Acta Médica Portuguesa ◽

10.20344/amp.2019 ◽

2013 ◽

Vol 26 (6) ◽

pp. 699

Author(s):

María de Jesús Angeles Vásquez ◽

Luis Emilio Reyes Mendoza ◽

Ricardo Mauricio Malagón Reyes ◽

Hugo Mendieta Zerón

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Open Abdomen ◽

Damage Control ◽

Damage Control Surgery ◽

Abdominal Sepsis ◽

History Of ◽

The Mean ◽

Surgical Option ◽

Previous Cesarean

Introduction: Current indications for open abdomen management are damage control surgery, severe intra-abdominal sepsis, abdominal compartment syndrome, abdominal wall closure under tension and mass loss of the abdominal wall.Objective: To describe the experience in open abdomen management using the MALA (mayor absorción de líquido abdominal [greater absorption of abdominal liquid]) bag at the Maternal-Perinatal Hospital Mónica Pretelini Saénz, Health Institute of the State of Mexico.Material and Methods: This was a bidirectional, descriptive and observational study. All patients with the diagnosis of open abdomen managed with the MALA bag admitted to the Obstetric Intensive Care Unit from February 2009 to June 2012 were included.Results: From 25 cases identified in the period of the study, seven were eliminated for incomplete files, remaining 18 cases for the analysis. The mean age was 31.5 years. 78% of the patients were multigravidas, 50% of them with a history of 2 or more deliveries, 83% had a previous cesarean section and 78% were hysterectomized. Evisceration was present in one patient. The main indication for surgical management was damage control. One patient died and a second was transferred to another institution, the rest were discharged by clinical improvement. 12 patients (67%) spent less than 14 days in the Obstetric Intensive Care Unit, only one patient required morethan 30 days in the unit. Discussion: Halve the women who required this surgical alternative, were above 30 years of age. Stressing is the fact that from the 18 admitted patients, 14 (78%) had undergone obstetric hysterectomy, with the etiology of uterine atony in most cases. Damage control surgery seems to be the most elective surgical option to use MALA bag followed by ACS and abdominal sepsis.Conclusion: The MALA bag can offer an economic and effective surgical option for the open abdomen management as well as adrainage technique.

Download Full-text

Damage Control Laparotomy for Severe Typhoid Fever: A Case Report

American Journal of Surgical Case Reports ◽

10.31487/j.ajscr.2020.03.07 ◽

2020 ◽

pp. 1-3

Author(s):

Abdirahaman Nuno ◽

Mokhtar Eltair ◽

T. A. Agarwal

Keyword(s):

Case Report ◽

Typhoid Fever ◽

Rare Case ◽

Open Abdomen ◽

Damage Control ◽

Abdominal Sepsis ◽

Multiple Organ ◽

Organ System ◽

Damage Control Laparotomy ◽

Wound Breakdown

Persistent intra-abdominal sepsis is a challenging complication of abdominal typhoid with a high mortality and difficult to manage. Delayed perforations following initial operative intervention is one of the rarer complications of this disease, causing wound breakdown and open abdomen, resulting in fistula. We present the management of a rare case, which presented with multiple perforations and multiple organ system dysfunction then complicated post-operatively with multiple fistula and open abdomen.

Download Full-text

Damage control surgery by keeping the abdomen open during pregnancy: favorable outcome, a case report

World Journal of Emergency Surgery ◽

10.1186/1749-7922-4-33 ◽

2009 ◽

Vol 4 (1) ◽

pp. 33 ◽

Cited By ~ 4

Author(s):

Wojciech Staszewicz ◽

Michel Christodoulou ◽

François Marty ◽

Vincent Bettschart

Keyword(s):

Case Report ◽

Damage Control ◽

Damage Control Surgery ◽

Favorable Outcome

Download Full-text

Cytokine clearance in serum and peritoneal fluid of patients undergoing damage control surgery with abdominal negative pressure therapy for abdominal sepsis

Pleura and Peritoneum ◽

10.1515/pp-2020-0122 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Seraina Faes ◽

Martin Hübner ◽

Nicolas Demartines ◽

Dieter Hahnloser

Keyword(s):

Pilot Study ◽

Negative Pressure ◽

Peritoneal Fluid ◽

Damage Control ◽

Damage Control Surgery ◽

Abdominal Sepsis ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Wide Range ◽

Planned Reoperation

AbstractObjectivesOpen abdomen technique with negative pressure therapy (NPT) is widely used in patients with severe abdominal sepsis. The aim of this study was to evaluate cytokine clearance in serum and peritoneal fluid during NPT.MethodsThis prospective pilot study included six patients with severe abdominal sepsis requiring discontinuity resection and NPT for 48 h followed by planned reoperation. Cytokines (IL6, IL8, IL10, TNFalpha, and IL1beta) were measured in the serum and peritoneal fluid during index operation, on postoperative days 0, 1, and 2.ResultsConcentrations of cytokines in peritoneal fluid were higher than in serum. IL10 showed a clearance both in serum (to 16.6%, p=0.019) and peritoneal fluid (to 40.9%, p=0.014). IL6 cleared only in serum (to 24.7%, p=0.001) with persistently high levels in peritoneal fluid. IL8 remained high in both serum and peritoneal fluid. TNFalpha and IL1beta were both low in serum with wide range of high peritoneal concentrations. Only TNFalpha in peritoneal fluid showed significant differences between patients with ischemia vs. perforation (p=0.006).ConclusionsThe present pilot study suggests that cytokines display distinct patterns of clearance or persistence in the peritoneal fluid and serum over the first 48 h of treatment in severe abdominal sepsis with NPT.

Download Full-text

Not All Abdomens Are the Same: A Comparison of Damage Control Surgery for Intra-abdominal Sepsis versus Trauma

The American Surgeon ◽

10.1177/000313481608200518 ◽

2016 ◽

Vol 82 (5) ◽

pp. 427-432 ◽

Cited By ~ 3

Author(s):

Jason W. Smith ◽

Nick Nash ◽

Levi Procter ◽

Matthew Benns ◽

Glen A. Franklin ◽

...

Keyword(s):

Damage Control ◽

Penetrating Trauma ◽

Damage Control Surgery ◽

Abdominal Sepsis ◽

Fascial Closure ◽

Trauma Patients ◽

Complication Rates ◽

Emergency General Surgery ◽

Risk Of Death ◽

Abdominal Complication

Damage control surgery (DCS) was developed to manage exsanguinating trauma patients, but is increasingly applied to the management of peritoneal sepsis and abdominal catastrophes. Few manuscripts compare the outcomes of these surgeries on disparate patient populations. A multi-institutional three group propensity score matched case cohort study comparing penetrating trauma (PT-DCS), blunt trauma (BT-DCS), and intraperitoneal sepsis (IPS-DCS) was performed comparing patients treated with DSC between 2008 and 2013. Propensity scoring was performed using demographic and presenting physiologic data. Four hundred and twelve patients were treated with DCS across two institutions. Propensity matching for age, gender, and initial Acute Physiology and Chronic Health Evaluation II score 80 identified 80 patients per group for comparison. Rate of primary fascial closure was lowest in the IPS-DCS group, and highest in the penetrating trauma DCS group. Intra-abdominal complication rates were highest in the IPS-DCS group. IPS-DCS had increased time to definitive closure compared with the other two groups (RR 1.8; 1.3–2.2; P < 0.03). Mortality at 90 days was highest in the IPS-DCS group and patients whose definitive closure was delayed >eight days were more than twice the risk of death at 90 days across all groups. (RR 2.15; 1.2–3.5; P < 0.002). Expected outcomes after the use of DCS for trauma and emergency general surgery are quite different. Despite this difference, prompt abdominal closure at the earliest possible opportunity afforded the best outcome in patients managed via DCS.

Download Full-text