A 45 year-old-female came into the ER with post-operative complication related to removal of the right ovary and both fallopian tubes due to a dermoid cyst (a type of tumor). Patient’s Body Mass Index was 60.9 Kg/m2 which is considered bariatric. On arrival to the emergency room, patient was awake and showing signs of septic shock such as extremely low blood pressure, inflammation of the body and abnormal organ function. Patient also had peritonitis, inflammation of inner lining of the abdominal wall & organs due to infection evident by swelling and tenderness of the belly. Patient’s abdominal CT scan showed free fluid and air, pelvic  abscess or pus collection, swollen bowel loops due to obstruction/blockage. Fluid replacement and antibiotics were administered to the patient before she was taken to the Operating Room (OR). Initially a laparoscopy was attempted which caused a trocar (a sharp surgical instrument) injury to the small bowel loop (a small obstructed/swollen area of the small intestines). 

Initial Damage Control Procedures

Injured part of the small intestine was removed and closed and rectal injury from gynecological procedure was sutured back. Patient received 14.3 L of fluids with electrolytes, salts and sugar (Crystalloids) and medication to elevate blood pressure (vasopressors) and also 2 Units of packed red blood cells (PRBC) to stabilize the patient’s low blood pressure and blood loss. 

Abdomen was left open as life-saving interventions were priority; more surgical procedures were required and fascial edges were not coming together. Abthera vacuum-assisted negative pressure dressing was used as temporary closure method as it helps to remove any fluid accumulation in the abdominal cavity. Patient was then taken to the ICU for care and management. Abdomen was open for 10 days while the care and management took place in the ICU to stabilize the patient. Within her time in the ICU patient was taken to the OR three times. The first OR visit was for a bowel surgery to reattach the intestine/bowel. Patient was taken to the OR for the second time on day 8 as the parts of the intestine that were reattached had started leaking and her abdominal cavity needed to be flushed and previous surgery needed to be reinforced. Finally on day 10 Vicryl Mesh was used to bridge the defect instead of attempting to close the fascia as forced closure can create added pressure in the abdominal cavity which can lead to pain, poor oxygen supply to organs and potentially organ failure. 

AbClo was used throughout the 10 days after the initial surgery to help decrease the fascial/open abdomen wound gap. A gradual decrease in the fascial defect was noted and maintained through the external traction applied through AbClo. Despite of the high BMI of 60.9Kg/M2, AbClo moved all layers of the abdominal wall evident in the CT scan.

Learn more about AbClo here.