Perforated second trimester appendicitis with abdominal compartment syndrome managed with negative pressure wound therapy and open abdomen

Abstract

Abdominal compartment syndrome (ACS) is a known complication of laparotomy; however, the literature is lacking in regards to treatment of this entity in pregnant patients. We present a case of acute perforated appendicitis in a second trimester primagravida, complicated by gangrenous necrosis of the contiguous bowel with subsequent development of ACS and intra-abdominal sepsis. This was treated with a novel approach, using non-commercial negative pressure wound therapy and open abdomen technique. Gestational integrity was preserved and the patient went on to experience a normal spontaneous vaginal delivery. At 5 years post-delivery the patient has had no surgical complications and her baby has met all developmental milestones.

Challenging Obstetrical Management in Generalized Peritonitis during Pregnancy

“…Turnock et al described a case of acute perforated second-trimester appendicitis associated with intraabdominal sepsis and abdominal compartment syndrome. They applied a temporary abdominal closure with negative pressure wound therapy for nearly 1 week with excellent surgical and obstetrical results [ 31 ]. In our report, the abdomen was left open for 4 days despite the gravid uterus, and the cooperation between surgical and obstetrics teams, with intensive care support, made the complete restoration of maternal health possible, reaching the best obstetrical outcome.…”

Laparostomy during pregnancy: A case report

“…Additionally, the possibility of abdominal abscess formation and predicted need of further peritoneal lavage lead to this option. The main issue with open abdominal techniques remains the progressive fascial retraction that can hamper definitive closure [ 10 ]. During pregnancy, this issue is worsened due to progressive and constant raise of intraabdominal pressure motivated by uterine growth [ 11 ].…”