Damage Control Surgery for Acute Mesenteric Ischemia, Bowel Perforation, and Faecal Peritonitis

Garcia-Granero A, Pellino G, Gamundi-Cuesta M and Gonzalez-Argente FX

Colorectal Unit, Hospital Universitario Son Espases, Spain
Department of Human Embryology and Anatomy, University of Valencia, Spain
Colorectal Unit, Hospital Vall d´Hebron, Spain
Department of Surgery, University of the Balearic Islands, Spain

^*Correspondance to: Francesc Xavier González-Argente 

 PDF  Full Text DOI: 10.25107/2474-1647.2576

Abstract

Introduction: Acute mesenteric ischemia brings about a risk of mortality as high as 75%. Because mesenteric ischemia can progress after surgery, the length of bowel resected is a surgical challenge. “Damage-control surgery “is based on temporary-abdominal-closure, resuscitation and adjustment of acid-base balance. “Second-look” laparotomy assesses the intestinal viability. We propose the “damage-control surgery” and “second-look” laparotomy as an available option to treat acute mesenteric ischemia with bowel perforation and faecal peritonitis. Material and Methods: Real case of 63-year-old patient, alcoholic cirrhosis Child b, admitted at emergency department with peritoneal irritation. Blood test: creatinine 4.09 mg/dl, C-reactive protein 176.7 mg/l, procalcitonin 14.83 ng/ml, lactate 3.50 mmol/l, and leucocytosis 26 × 103/μl. CTscan: pneumoperitoneum and diffuse intestinal ischemia. Faecal peritonitis and intestinal necrosis during emergency surgery was found. Results: Thirty cm of terminal jejunum and proximal ileum and 10 cm of terminal ileum were resected. Because of hemodynamic instability and uncertain intestinal viability small bowel stumps were left closed in the abdomen. Temporary-abdominal-closure was performed. After 72 h in the intensive care unit a “second-look” laparotomy was done. Two anastomoses and definitive laparotomy closure was performed. He was discharged on postoperative day 16th from the second operation. Discussion: “Damage-control surgery” and “second-look” laparotomy are good option to acute mesenteric ischemia surgical management. Re-laparotomy should be performed 48 h to 72 h after index surgery and the decision to perform an anastomosis, a stoma, or another small bowel resection should be based on the evolution in ICU, the hemodynamic status, and the intraoperative findings.

Keywords

Acute mesenteric ischemia; Damage control surgery; SLL; TAC

Cite the article

Garcia-Granero A, Pellino G, Gamundi-Cuesta M, Gonzalez-Argente FX. Damage Control Surgery for Acute Mesenteric Ischemia, Bowel Perforation, and Faecal Peritonitis. Clin Surg. 2019; 4: 2576..