OPEN MANAGEMENT OF THE SEPTIC ABDOMEN

Severe intraabdominal infection associated with abdominal wall, intraperitoneal and remote organ complications, still carries an unacceptably high morality rate. In addition to the fundamental principle of eradication of the source of infection, various treatment modalities have been suggested to improve the commonly grave outcome. Amongst these, open management (OM) of the septic abdomen, even though based at least theoretically on sound physiologic principles, has not been generally accepted as an uncontroversial method of treatment due to the many and varied complications associated with it. Frustrating efforts in the treatment of severe intraabdominal infection (IAI) led us to investigate a method of open management while avoiding the complications which others have encountered. What you will read in this report are new, innovative techniques in the open management of JAJ which will obviate the complictions of leaving the peritoneal cavity open, such as disruption of anastomoses, evisceration, the need for assisted respiration after paralyzing the patient to prevent evisceration, recurrent abscess formation and need for reexploration to drain such abscesses, complications associated with late closure of the abdominal wall due to severe adhesions, and the negative nitrogen balance existing in such patients. 40 patients have been treated with this method after conventional treatment failure and continued deteriorating condition. Almost all patients had one organ failure (kidney, liver, brain, etc.), and some had multiple organ failure associated with hepatorenal syndrome requiring hemodialysis. Nearly all patients were referred to us in grave condition and were put on this study. The case selection, assessment of patients, preoperative evaluation and preparation, detailed operative technique and post-operative care, along •with the final results are discussed. We are recommending this technique as a sound and safe method of management of severe intraabdominal sepsis, and a modality of treatment with an acceptable mortality rate.