Damage control with abdominal vacuum therapy (VAC) to manage perforated diverticulitis with advanced generalized peritonitis—a proof of concept

Perathoner, Alexander; Alexander, Klaus; Mühlmann, Gilbert; Oberwalder, Michael; Margreiter, Raimund; Kafka-Ritsch, Reinhold

doi:10.1007/s00384-010-0887-8

Cited by 76 publications

(69 citation statements)

References 28 publications

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“…In a non-randomized study of 27 consecutive patients with perforated diverticulitis (Hinchey III/IV), the patients were managed either with sigmoid resection and primary anastomosis, or limited sigmoid resection or suture, open abdomen and primary anastomosis or colostomy at second operation 24–48 hours later, or Hartmann procedure; sigmoid resection and end colostomy [117]. All 6 patients with primary anastomosis survived without complications, but there was an obvious selection bias.…”

Section: Source Controlmentioning

confidence: 99%

Current concept of abdominal sepsis: WSES position paper

Sartelli

Catena²,

Saverio³

et al. 2014

World J Emerg Surg

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Although sepsis is a systemic process, the pathophysiological cascade of events may vary from region to region.Abdominal sepsis represents the host’s systemic inflammatory response to bacterial peritonitis.It is associated with significant morbidity and mortality rates, and is the second most common cause of sepsis-related mortality in the intensive care unit.The review focuses on sepsis in the specific setting of severe peritonitis.

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Section: Source Controlmentioning

confidence: 99%

Current concept of abdominal sepsis: WSES position paper

Sartelli

Catena²,

Saverio³

et al. 2014

World J Emerg Surg

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“…Improvements in TAC techniques, however, led to higher fascial closure rates [54]. Recent studies have indeed shown DCS to be a feasible technique in patients with generalized peritonitis [55,56]. …”

Section: Damage Control Surgerymentioning

confidence: 99%

Open abdomen management: A review of its history and a proposed management algorithm

2013

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In this review we look into the historical development of open abdomen management. Its indication has spread in 70 years from intra-abdominal sepsis to damage control surgery and abdominal compartment syndrome. Different temporary abdominal closure techniques are essential to benefit the potential advantages of open abdomen management. Here, we discuss the different techniques and provide a new treatment strategy, based on available evidence, to facilitate more consistent decision making and further research on this complicated surgical topic.

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“…These were the techniques used in our AVS management, which allowed for effective peritoneal drainage and also protected the open wound from contamination with enteric contents. In addition, the gauze dressings should be changed frequently, every 2–3 days, even without macroscopic pollution [14]. …”

Section: Discussionmentioning

confidence: 99%

Complete abdominal wound and anastomotic leak with diffuse peritonitis closure achieved by an abdominal vacuum sealing drainage in a critical ill patient: a case report

et al. 2018

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BackgroundNegative pressure wound therapy (NPWT) is a widely accepted technique to treat local infectious wounds of the skin, subcutaneous tissue, fascia, or muscle. Recently, several reports describing the efficacy of NPWT for various types of fistulas and anastomotic leaks have been published. We herein describe a patient with an open abdominal wound due to colonic anastomotic leakage and diffuse peritonitis, in whom abdominal vacuum sealing (AVS) as a modified NPWT was useful for the management of this complex wound.Case presentationA 32-year-old man was admitted to our hospital with late presenting traumatic diaphragmatic hernia and strangulated ileum complicated by necrosis of the ileum and transverse colon. He had a history of cervical spinal cord injury due to suicide attempt 14 years earlier and, as a result of cervical spinal cord injury, he was paralyzed in the lower body. The patient underwent an urgent hernia repair and bowel resection. Postoperatively, he developed severe septic shock. On postoperative day (POD) 6, wound dehiscence due to colonic anastomotic leakage with diffuse peritonitis was diagnosed, but he was unable to undergo re-operation because of refractory severe septic shock combined with neurogenic shock due to the cervical cord injury. The patient was treated with AVS therapy. He gradually recovered from septic shock, and the anastomotic leakage healed after a 2-month period. The wound dehiscence was also reduced. The patient resumed oral intake on POD 112 and was discharged on POD 190.ConclusionsAlthough surgical repair would be the best method for the treatment of diffuse peritonitis due to gastrointestinal perforation or anastomotic leakage, our case suggests that AVS with ‘conventional’ drainage is a treatment of choice for open abdominal wounds even in the presence of diffuse peritonitis caused by intestinal anastomotic leakage, especially in patients with poor general medical condition.

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Damage control with abdominal vacuum therapy (VAC) to manage perforated diverticulitis with advanced generalized peritonitis—a proof of concept

Abstract: Damage control with lavage, limited bowel resection, VAC, and scheduled second-look operation represents a feasible strategy in patients with perforated diverticulitis (Hinchey III and IV) to enhance sepsis control and improve rate of anastomosis.

Cited by 76 publications

References 28 publications

Current concept of abdominal sepsis: WSES position paper

Current concept of abdominal sepsis: WSES position paper

Open abdomen management: A review of its history and a proposed management algorithm

Complete abdominal wound and anastomotic leak with diffuse peritonitis closure achieved by an abdominal vacuum sealing drainage in a critical ill patient: a case report

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