Table 1: The recognized indications for the open abdomen treatment.

IndicationSpecific situation vignettes

IAI(1) Source control unsatisfied; (2) SIRS or sepsis predicted; (3) hypovolemic shock resulted from complicated fluid loss or hemorrhage unavoidable; (4) immunocompromised status presented.

DCS for severe trauma(1) Death triangle (hypothermia <35°C, severe acidosis with base deficit >15 mmol/L, and coagulopathy) emerged; (2) the abdomen cannot be closed primarily due to extensive abdominal wall defection; (3) life-threatening intra-abdominal bleeding suspected or confirmed; (4) interventional therapy for hemostasis failed.

Persistent IAH/ACS(1) IAP by bladder pressure measurements >20 mmHg more than 48 h; (2) sustained IAP >20 mmHg (with/without an abdominal perfusion pressure <60 mmHg) and at least one organ dysfunction present, in particular for kidney dysfunction. (3) Pulmonary and cardiac function declined significantly; (4) other decompression measures (percutaneous drainage, diuresis, etc.) unsatisfied.

Acute mesenteric ischemia(1) The need for a mandatory “second look” to evaluate bowel viability and resect additional ischemic bowel segments if necessary; (2) persistent IAH developed, complying with ileus or intestinal necrosis.

Necrotizing infection of the abdominal wall(1) The infection mainly originated from the endogenous microflora, frequently associated with complications of initial laparotomy; (2) bacterial translocation can be predicted through clinical indexes; (3) necrotizing tissues cannot be repaired from conventional therapies; (4) complicated compartment syndrome occurred.

IAI: intra-abdominal infection; IAH: intra-abdominal hypertension; IAP: intra-abdominal pressure; ACS: abdominal compartment syndrome; SIRS: systematic inflammatory reaction syndrome.