This case discusses a 41-year-old-male who came through the hospital doors with a gunshot wound to the abdomen; with a of BMI 31.1 Kg/m2. On arrival at the Trauma Center, patient was awake and his blood pressure was very low. The chest X-ray revealed that he had collection of air in his right lung cavity (Pneumothorax) and to manage that, a chest tube was inserted into his lung. Chest tubes are used to create negative pressure in the chest cavity to allow re-expansion of the lung(s). Pelvic (lower abdomen) X-ray revealed a bullet in the pelvis. Fast ultrasound showed collection of abdominal fluid.

Care and Management

Massive transfusion protocol (MTP) was initiated for patient to receive large amount of blood product rapidly in response to the blood loss. Also, Tranexamic Acid (TXA) which is used to stop the dissolving of blood clots was administered to control further bleeding. Patient was then taken to the Operating Room (OR) for the removal of the bullet and to prevent abdominal compartment syndrome as collection of blood and fluid can suffocate the organs which can lead to organ failure. 

OR Management

In the OR multiple things were managed during the surgery including expanding retroperitoneal pelvic hematoma which is mass bleeding in the area in the back of the abdomen and perforated cecum and right colon which are parts of the large intestines. Initial Damage Control procedures included vascular exploration of pelvic vessels as during trauma injuries, network of tubes through which blood is pumped can get damaged. The right side of the colon was removed (right hemicolectomy) and then left closed until stabilization of the patient. Packing of non-surgical bleed in the pelvis was conducted in which sterile gauze is packed over the bleeding source. Patient’s severely low blood pressure was managed by giving him IV fluids with electrolytes and glucose (crystalloids) and medication to elevate their blood pressure (Vasopressors). Patient also received 5 units of packed red blood cells (PRBC) and 2 units of fresh frozen plasma which replaces the fluid in blood after heavy blood loss and helps to control bleeding by adding clotting factor to the blood.  It was decided to leave the abdomen open as serial surgical interventions were required. 

The open abdomen was temporarily covered with vacuum-assisted negative pressure wound dressing. Finally interventional radiology was conducted to rule out any post-operation complications such as bowel leaks or active bleeding. AbClo in this case was applied to the open abdomen 24 hours later as the surgical team had not received orientation on AbClo use and application. 

Patient was taken to the surgery room twice to conduct more surgical procedures with in the 7 days where the abdomen was left open. On the day of last surgery/closure surgery (day 7), patient received 10lts of fluid to regain fluid and electrolyte balance and an ileostomy was conducted on the patient. This was the last intervention in which part of the small bowel is brought through the abdominal wall via surgically created opening called stoma to divert the flow and evacuation of stool. The Fascial defect was closed, and primary closure was achieved with no complications.

Learn more about another case study featuring an 80-year-old with chronic kidney failure here.

Learn more about AbClo here.