Open Abdomen in Trauma and Critical Care

Abstract

The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia. Determining the need for this poten- T he open abdomen is a technique with recently expanded implementation in managing complex problems in critically ill patients. First used in trauma care in the 1990s, the technique is now a management strategy for many other illnesses and conditions in critically ill adults. The mainstay of treatment for intra-abdominal infections, intra-abdominal bleeding, and abdominal compartment syndrome (ACS), whatever the cause, is the intentional creation of an open abdomen, which is a laparotomy wound that allows a damaged or edematous viscera to expand, reducing intra-abdominal pressure (IAP) and related complications.1 The technique of the open abdomen is defi ned as intentionally leaving the fascial edges of the abdomen unapproximated (laparostomy) through a surgically created entrance into the cavity. As a result, the abdominal contents are exposed but are protected by a temporary 22

Current status of diagnosis and Mesenchymal stem cells therapy for acute pancreatitis

“…(Yadav and Lowenfels, ; Yadav and Lowenfels, ) About 20% of cases are caused by alcohol, which is the second leading cause of AP (Apte, Pirola and Wilson, ; Coté et al, ; Whitcomb et al, ). Other relatively rare causes include drug therapy (Nitsche et al, ), ERCP (Cotton et al, ), hypercalcemia (Bai et al, ), hypertriglyceridemia (Stefanutti, Labbadia and Morozzi, ), surgery and trauma (Fitzpatrick, ) (Fig. ).…”

Terapia por pressão subatmosférica de baixo custo como alternativa para fechamento abdominal temporário em hospital público: relato de caso

“…Kamamoto 5 , in his doctoral thesis, proved that the use of barker's technique modified for traumatic wounds obtained significantly statistical outcomes when compared with VAC ® in the same pathologies, associated with great cost reduction, being the treatment of choice in the orthopedics service of the University of Sao Paulo.…”

“…Although Bruhin et al 7 recommended the continuous use of sub atmospheric pressure with negative 80 mmHg, other studies claimed that higher continuous pressures are associated with better results in angiogenesis and approximation of wound edges 5 . When choosing the pressure level, a balance should be found between potential damage to the underlying organs (supporting lower pressures) and effective fluid removal (negative pressures of up to 120 mmHg leads to greater fluid drainage).…”

Transcatheter Arterial Embolization in the Treatment of Abdominal Bleeding in Patients Being Treated with Open Abdomen Due to Duodenal Fistula

“…Recent development has made damage control surgery (DCS) the standard treatment for potentially lethal bleeding [9]. DCS seems to be very suitable for patients with severe abdominal bleeding who are already treated with OA.…”