A novel approach to severe acute pancreatitis in sequential liver-kidney transplantation: the first report on the application of VAC therapy.
This work is the first report of vacuum-assisted closure (VAC) therapy applied as a life-saving surgical treatment for severe acute pancreatitis occurring in a sequential liver- and kidney-transplanted patient who had percutaneous biliary drainage for obstructive "late-onset" jaundice. Surgical exploration with necrosectomy and sequential laparotomies was performed because of increasing intra-abdominal pressure with hemodynamic instability and intra-abdominal multidrug-resistant sepsis, with increasingly difficult abdominal closure. Repeated laparotomies with VAC therapy (applying a continuous negative abdominal pressure) enabled a progressive, successful abdominal decompression, with the clearance of infection and definitive abdominal wound closure. The application of a negative pressure is a novel approach to severe abdominal sepsis and laparostomy management with a view to preventing compartment syndrome and fatal sepsis, and it can lead to complete abdominal wound closure.
General Surgery and Organ Transplantation, Hepatobiliary Surgery and Liver Transplant Unit, Azienda Università di Padova, Padova, Italy.
Giacomo
G
Zanus
Riccardo
R
Boetto
Francesco
F
D'Amico
Enrico
E
Gringeri
Alessandro
A
Vitale
Amedeo
A
Carraro
Domenico
D
Bassi
Michele
M
Scopelliti
Pasquale
P
Bonsignore
Patrizia
P
Burra
Paolo
P
Angeli
Paolo
P
Feltracco
Umberto
U
Cillo
D000005:Abdomen / Q000601:surgery; D058107:Abdominal Wound Closure Techniques; D003161:Compartment Syndromes / Q000517:prevention & control; D006801:Humans; D007049:Iatrogenic Disease; D041781:Jaundice, Obstructive / Q000601:surgery*; D016030:Kidney Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology / Q000601:surgery*; D018805:Sepsis / Q000601:surgery