Current Status of the Open Abdomen Treatment for Intra-Abdominal Infection
Table 2
Open-abdomen-associated complications in patients with intra-abdominal infection.
Complication
Possible reasons
Enteroatmospheric fistulae
(1) The bowel is exposed into air and allowed to desiccate; (2) “biomaterial adherence” to the bowel would lead to transmural changes of the bowel wall; (3) bowels became edema and vulnerable to bacteria invasion due to the capillary leak syndrome; (4) persistent negative nitrogen balance complicated from IAI; (5) decreased intestinal microvessel circulation from IAH or surgical packing; (6) delayed perforation due to operation associated injuries.
Fluid, protein, and heat loss
(1) A large, moist surface area of the intestine is exposed and could suffer huge evaporative water losses, further deteriorated if enteroatmospheric fistula occurred; (2) the increased metabolic demands during IAI, combined with the loss of bowel motility; (3) relatively poor nutrition status and rapid accumulation of third space fluid.
Bleeding/hemorrhage
(1) Given the rich blood supply of bowels and splanchnic organs, the risk of bleeding is significantly increased, especially when inflamed or traumatized bowel wall is exposed to air; (2) the infected patients with an open abdomen often have an associated coagulopathy from hypothermia, acidosis, hypotension, dilution of blood volume, and uncontrolled exhaustion of clotting factors; (3) extensive complement activation or complement depletion disrupts the coagulation system.
Postoperative ileus
(1) Massive electrolyte loss from the exposed wound areas after an open abdomen, in particular for potassium and magnesium; (2) postoperative adhesion often occurred after the initial operation.
Abdominal wall hernia
(1) Extensive abdominal wall defect cannot be repaired with skin-only closure; (2) planned reconstruction surgery is required due to a wide resection of abdominal fascia in initial OA procedure.
Bacterial translocation/ sepsis/MODS/MOF
Mucous damages from the capillary leak syndrome and vicious cycle related to infected open abdomen (Figure 1).
SSI/VAP/ARDS/UTI
Declined immune function because of sustained infection status; iatrogenic infection.
Intra-abdominal abscess
Concealed infection source or secondary perforation fixed by greater omentum.
