title: Review of abdominal damage control and open abdomens: focus on gastrointestinal complications.
abstract: Massive trauma and abdominal catastrophes carry high morbidity and mortality. In addition to the primary pathologic process, a secondary systemic injury, characterized by inflammatory mediator release, contributes to subsequent cellular, end-organ, and systemic dysfunction. These processes, in conjunction with large-volume resuscitations and tissue hypoperfusion, lead to acidosis, coagulopathy, and hypothermia. This "lethal triad" synergistically contributes to further physiologic derangements and, if uncorrected, may result in patient death. One manifestation of the associated clinical syndrome is the development of intra-abdominal hypertension (IAH) and the abdominal compartment syndrome (ACS). The development of ACS is insidious. If not recognized and treated promptly, ACS leads to multi-system organ failure (MSOF) and mortality. Improved understanding of IAH and ACS led to the development of damage control (DC)/open abdomen (OA) as surgical decompressive strategy. The DC/OA approach consists of three basic management steps. During the initial step the abdomen is opened, hemorrhage/abdominal contamination are controlled, and temporary abdominal closure is performed (Stage I). The patient then enters Stage II - physiologic restoration with core rewarming, correction of coagulopathy and completion of acute resuscitation. After physiologic normalization, definitive management of injuries and eventual abdominal closure (Stage III) are achieved. The authors will provide an overview of the DC/OA approach, as well as the clinical diagnosis of ACS, followed by a discussion of DC/OA-associated complications, with focus on digestive system-specific complaints.
authors.affiliation: Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Smith
authors.forename: Raeanna C
authors.initials: RC
authors.lastname: Adams
authors.forename: Vijay A
authors.initials: VA
authors.lastname: Doraiswamy
authors.forename: Vivek
authors.initials: V
authors.lastname: Nagaraja
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Seamon
authors.forename: Johathan
authors.initials: J
authors.lastname: Wisler
authors.forename: James
authors.initials: J
authors.lastname: Cipolla
authors.forename: Rohit
authors.initials: R
authors.lastname: Sharma
authors.forename: Charles H
authors.initials: CH
authors.lastname: Cook
authors.forename: Oliver L
authors.initials: OL
authors.lastname: Gunter
authors.forename: Stanislaw Pa
authors.initials: SP
authors.lastname: Stawicki
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D058107:Abdominal Wound Closure Techniques / Q000009:adverse effects; D003161:Compartment Syndromes / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D016638:Critical Illness; D019299:Decompression, Surgical / Q000009:adverse effects; D006489:Hemostatic Techniques; D006801:Humans; D009102:Multiple Organ Failure / Q000209:etiology; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D011312:Pressure; D017694:Rewarming; D016896:Treatment Outcome