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Current Opinion in Critical Care Dec 2021The aim of this study was to outline the management of the patient with the open abdomen. (Review)
Review
PURPOSE OF REVIEW
The aim of this study was to outline the management of the patient with the open abdomen.
RECENT FINDINGS
An open abdomen approach is used after damage control laparotomy, to decrease risk for postsurgery intra-abdominal hypertension, if reoperation is likely and after primary abdominal decompression.Temporary abdominal wall closure without negative pressure is associated with higher rates of intra-abdominal infection and evisceration. Negative pressure systems improve fascial closure rates but increase fistula formation. Definitive abdominal wall closure should be considered once oedema has subsided and the patient has stabilized. Delayed abdominal closure after trauma (>24-48 h) is associated with less achievement of fascial closure and more complications. Protective lung ventilation should be employed early, particularly if respiratory compromise is evident. Conservative fluid management and less sedation may decrease delirium and increase definitive abdominal closure rates. Extubation may be performed before definitive abdominal closure in selected patients. Antibiotic therapy should be brief, targeted and guideline concordant. Survival depends on the underlying disease, the closure method and the course of hospitalization.
SUMMARY
Changes in the treatment of patients with the open abdomen include negative temporary closure, conservative fluid management, early protective lung ventilation, decreased sedation and extubation before abdominal closure in selected patients.
Topics: Abdomen; Abdominal Cavity; Abdominal Injuries; Humans; Intra-Abdominal Hypertension; Laparotomy; Retrospective Studies
PubMed: 34561356
DOI: 10.1097/MCC.0000000000000879 -
World Journal of Emergency Surgery :... Jul 2023Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI)... (Review)
Review
Intra-abdominal infections (IAI) are among the most common global healthcare challenges and they are usually precipitated by disruption to the gastrointestinal (GI) tract. Their successful management typically requires intensive resource utilization, and despite the best therapies, morbidity and mortality remain high. One of the main issues required to appropriately treat IAI that differs from the other etiologies of sepsis is the frequent requirement to provide physical source control. Fortunately, dramatic advances have been made in this aspect of treatment. Historically, source control was left to surgeons only. With new technologies non-surgical less invasive interventional procedures have been introduced. Alternatively, in addition to formal surgery open abdomen techniques have long been proposed as aiding source control in severe intra-abdominal sepsis. It is ironic that while a lack or even delay regarding source control clearly associates with death, it is a concept that remains poorly described. For example, no conclusive definition of source control technique or even adequacy has been universally accepted. Practically, source control involves a complex definition encompassing several factors including the causative event, source of infection bacteria, local bacterial flora, patient condition, and his/her eventual comorbidities. With greater understanding of the systemic pathobiology of sepsis and the profound implications of the human microbiome, adequate source control is no longer only a surgical issue but one that requires a multidisciplinary, multimodality approach. Thus, while any breach in the GI tract must be controlled, source control should also attempt to control the generation and propagation of the systemic biomediators and dysbiotic influences on the microbiome that perpetuate multi-system organ failure and death. Given these increased complexities, the present paper represents the current opinions and recommendations for future research of the World Society of Emergency Surgery, of the Global Alliance for Infections in Surgery of Surgical Infection Society Europe and Surgical Infection Society America regarding the concepts and operational adequacy of source control in intra-abdominal infections.
Topics: Female; Humans; Male; Surgeons; Abdominal Cavity; Intraabdominal Infections
PubMed: 37480129
DOI: 10.1186/s13017-023-00509-4 -
Critical Care (London, England) Mar 2020This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at... (Review)
Review
This article is one of ten reviews selected from the Annual Update in Intensive Care and Emergency Medicine 2020. Other selected articles can be found online at https://www.biomedcentral.com/collections/annualupdate2020. Further information about the Annual Update in Intensive Care and Emergency Medicine is available from http://www.springer.com/series/8901.
Topics: Abdominal Cavity; Compartment Syndromes; Critical Illness; Disease Management; Humans; Intensive Care Units; Intra-Abdominal Hypertension
PubMed: 32204721
DOI: 10.1186/s13054-020-2782-1 -
RoFo : Fortschritte Auf Dem Gebiete Der... Oct 2023
Topics: Abdomen; Abdominal Cavity
PubMed: 37793383
DOI: 10.1055/a-2101-8973 -
Revista Espanola de Enfermedades... Apr 2023Gastrointestinal tuberculosis (TB) is a rare disease and only involves the duodenum in 2-2,5% of all cases. A 60-year-old female with no reported medical history,...
Gastrointestinal tuberculosis (TB) is a rare disease and only involves the duodenum in 2-2,5% of all cases. A 60-year-old female with no reported medical history, presented with constitutional syndrome with a 10 kg weight loss in three months, epigastric pain, bloating and vomiting. She denied fever or respiratory symptoms. Laboratory examination revealed elevated C-reactive protein levels and low prealbumin. Abdominal computed tomography (CT) showed duodenal wall thickening, mainly in its third part, with infiltration of the root of the mesentery and numerous subcentimeter adenopathies at that level.
Topics: Female; Humans; Middle Aged; Duodenum; Abdomen; Abdominal Pain; Mesentery; Tuberculosis, Gastrointestinal
PubMed: 36695766
DOI: 10.17235/reed.2023.9373/2022 -
Urology Feb 2020
Topics: Abdominal Cavity; Male; Urethra
PubMed: 32033676
DOI: 10.1016/j.urology.2019.09.051 -
Rozhledy V Chirurgii : Mesicnik... 2021Open abdomen is known as a serious consequence of various intra-abdominal pathologies. Initially, patients often have a life-threatening condition, sepsis or septic...
Open abdomen is known as a serious consequence of various intra-abdominal pathologies. Initially, patients often have a life-threatening condition, sepsis or septic shock. Severe stress related malnutrition, mineral and fluid imbalance develop as metabolic consequences. Intestinal fistulas also occur as a frequent complication in patients with open abdomen. In such patients, a comprehensive approach is needed, including rehabilitation, nutritional support using optimal formulas, and local care for the open abdomen. Our case report presents a patient with open abdomen and enterocutaneous fistulation. A complex nutritional approach in the course of the disease is described and its importance is discussed. Finally, a summary of nutritional care for open abdomen patients is provided based on current recommendations.
Topics: Abdomen; Abdominal Cavity; Humans; Intestinal Fistula; Sepsis; Shock, Septic
PubMed: 33910341
DOI: No ID Found -
AORN Journal May 2021
Topics: Abdomen; Abdomen, Acute; Abdominal Cavity; Humans
PubMed: 33929744
DOI: 10.1002/aorn.13407 -
Abdominal Radiology (New York) Nov 2020Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential... (Review)
Review
Mesenteries are extensions of the visceral and parietal peritoneum consisting of fat, vessels, nerves, and lymphatics. Mesenteric masses have a wide differential diagnosis with neoplastic, infectious, or inflammatory etiologies and can either be solid or cystic. Imaging features are critical for the diagnosis. We review the epidemiology, imaging spectrum, and differentiating features and treatment of mesenteric masses.
Topics: Diagnosis, Differential; Humans; Mesentery; Peritoneal Neoplasms; Peritoneum; Tomography, X-Ray Computed
PubMed: 32300835
DOI: 10.1007/s00261-020-02535-1 -
Magyar Sebeszet Nov 2021Introduction: Not only atraumatic surgical technique, precise bleeding control, removal foreign materials from the abdomen, but also avoiding desiccation or mechanical... (Review)
Review
Introduction: Not only atraumatic surgical technique, precise bleeding control, removal foreign materials from the abdomen, but also avoiding desiccation or mechanical damage of peritoneal surface at abdominal surgery mean today evidence based expectation. Peritoneum with its extensive surface and special histological structure represents an important factor in normal physiological processes, furthermore as “Guard of abdomen” it has an important role to localise inflammatory reactions, useful as dialysing surface and provides also possibility for hyperthermic abdominal chemotherapy in tumour treatment. Largest part of peritoneal sac covers small intestine and colon. To prevent postoperative complications it is necessary to avoid desiccation of intestinal tract at laparoscopic and at open procedures as well – consequently “rehyration” is a routine recommendation today. Desiccation of intestinal tract results postoperative adhesions, furthermore damage of serosa will increase permeability of intestine wall and can result perforation. All the surgical recommendations suggest keeping intestine moist, whereas there are only a few real studies in surgical literature to support or to deny this theory. Our study reviews the pathophysiological and surgical respects of this situation and summarizes the results of latest researches of combined functions of peritoneum.
Topics: Humans; Laparoscopy; Peritoneum; Postoperative Complications
PubMed: 34821584
DOI: 10.1556/1046.74.2021.4.7