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Management of the open abdomen in adults

Authors
Niels Martin, MD, FACS
Babak Sarani, MD, FACS, FCCM
Section Editor
Eileen M Bulger, MD, FACS
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

The term “open abdomen” refers to a defect in the abdominal wall that exposes the abdominal viscera. Damage control surgery associated with trauma and abdominal compartment syndrome are the most frequent reasons for leaving an abdomen open. Open abdomen exposes the viscera and leads to fluid and heat loss, which can be reduced with temporary abdominal closure techniques until the abdomen can be closed primarily, closed functionally, or graft coverage of the exposed viscera provided.

The care of the patient with an open abdomen, techniques for placement of temporary abdominal dressings and timing and methods of abdominal closure will be reviewed here. The diagnosis and management of abdominal compartment syndrome is discussed in detail elsewhere. (See "Abdominal compartment syndrome in adults".)

OPEN ABDOMEN

Open abdomen is an abdominal wall defect created by intentionally leaving an abdominal incision open at the completion of intraabdominal surgery or by opening (or re-opening) the abdomen because of concern for abdominal compartment syndrome. Open abdomen can also be the result of injuries to the abdominal wall that produce significant soft tissue defects. The indications for open abdomen vary from region to region. As an example, in the United States, the most common indication for open abdomen is damage control surgery related to managing abdominal trauma [1], whereas in a review from the United Kingdom, the most common indication for open abdomen was abdominal sepsis [2].

Open abdomen is managed with temporary abdominal closure using one of several techniques, followed by interval abdominal closure, preferably by bringing the edges of the abdominal fascia together primarily (primary closure) or, if this is not feasible, using a functional closure or simple coverage. The techniques of temporary closure and closure of the abdomen are discussed below. (See 'Temporary abdominal closure' below and 'Abdominal closure' below.)

Etiologies — The most common circumstances that result in open abdomen include the following:

                        

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Literature review current through: Nov 2016. | This topic last updated: Mon Aug 08 00:00:00 GMT+00:00 2016.
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