Abdominal Catastrophe – Abdominal Wall Defect Associated with Gastrointestinal Fistula – Strategy of Therapy

Czech version

Authors: M. Chobola ¹; L. Sobotka ²; A. Ferko ¹; M. Oberreiter ³; M. Kaška ¹; V. Motyčka ¹; J. Páral ³; R. Mottl ²
Authors‘ workplace: Chirurgická klinika Fakultní nemocnice Hradec Králové a Lékařské fakulty UK v Hradci Králové přednosta kliniky: prof. MUDr. A. Ferko, CSc., vedoucí katedry chirurgie: doc. MUDr. RNDr. M. Kaška, Ph. D. ¹; Klinika gerontologická a metabolická Fakultní nemocnice Hradec Králové a Lékařské fakulty UK v Hradci Králové, přednosta kliniky: prof. MUDr. L. Sobotka, CSc. ²; Katedra válečné chirurgie, Fakulta vojenského zdravotnictví, Univerzita Obrany Brno vedoucí katedry: doc. MUDr. L. Klein, CSc. ³
Published in: Rozhl. Chir., 2010, roč. 89, č. 11, s. 672-678.
Category: Monothematic special - Original

Overview

Background:
Wound dehiscence complicated by gastrointestinal (GI) fistula to belong „abdominal catastrophe”. Therapy is prolonged and connected with high morbidity and mortality rate.

Methods:
In the period from October 2006 to July 2009 we performed 12 reconstructive surgical procedures on gastrointestinal tract in patients with abdominal catastrophe. Treatment of 12 consecutive patients (9 men, 3 women) was managed according to a standardize protocol. The protocol consists of treatment of septic complications, optimisation of nutritional state, special wound procedures, diagnosis of gastrointestinal fistulas and GI tract, timing of surgical procedures, reconstruction of GI tract and postoperative care.

Results:
Reconstructive surgery of GI tract was successful on 11 patients. One patient developed recurrence of early GI fistula. In four patients we let open abdomen to heal per secundam. We observed no deaths after operation.

Conclusion:
With regard to complex character of therapy of abdominal catastrophe there is a need of multidisciplinary approach. Considering long-lasting and expensive therapy there is logical step to concentrate these patients into special centres which are experienced, equipped and their staff is trained in treatment of such a seriously impaired patients.

Key words:
wound dehiscence – gastrointestinal fistula – abdominal catastrophe – reconstructive surgery of gastrointestinal tract

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