Manejo Multidisciplinario del Abdomen Catastrófico en la Unidad de Falla Intestinal

Abstract

The term catastrophic abdomen was first used in 1937, defined as a severe condition of a surgical patient that has usually required more tan two laparotomies associated to intestinal transit disorder, sepsis and intestinal anastomosis leakage. They mostly origin from acute surgical pathology. Incidence is low, approximately 1/100,000; however mortality can be as high as 50%.

This is a descriptive study of 8 patients, between 2015 and 2017, that had a diagnosis of catastrophic abdomen and were treated under a multidisciplinary approach at the Intestinal Unit of the Guillermo Almenara National Hospital (EsSalud).

Multidisciplinary approach allowed for intervention of each specialist at different stages, guided by a protocol. We describe the management of patients with “catastrophic abdomen” following these stages: 1. Control of the abdominal focus, 2. Nutritional and metabolic support, 3. Management of the open abdomen, 4. Stomal and periostomal therapy, 5. Diagnosis and treatment of intestinal pathology, and finally 6. Autologous reconstruction of the G-I tract (CRATGI). 

We conclude that despite the severity of intestinal injury and the high demand of resources for care in hospital, as well as prolonged time of stay, these patients can be managed in a specialized unit with favourable outcomes,decreasing both morbidity and mortality.