Abordaje del paciente con abdomen abierto. Revisión de la literatura

Abstract

Introduction: The catastrophic abdomen is a situation in which the abdominal cavity is open, the edges are retracted and compressed into a single set of fibrous tissue that prevents its adequate dissection with the presence of fragile loops of small intestines adhered to each other, often complicated with enterocutaneous or enteroatmospheric fistulas that are associated with a high degree of morbidity and mortality close to 40%, thus conditioning the quality of life of the patient. Management represents a challenge for the surgeon since it requires a multidisciplinary approach, especially in the ICU, and, in most patients, it is necessary to combine complex therapies. Treatment usually begins with a conservative approach that avoids the risks of major surgery. Objective: To critically analyze the updated scientific evidence on the open abdomen as a surgical technique. Material and methods: The theoretical support of this work is obtained by research and analysis of specialized consultation documents such as scientific articles, magazines, books, and additional physical and virtual documents through search engines and medical bibliography databases. Conclusions: The clinical approach focuses on hemodynamic stabilization of the patient, avoiding malnutrition and rational use of antibiotic therapy; while the surgical approach seeks adequate closure of the abdominal wall, for which several temporary and definitive closure techniques have been developed; however, neither is the gold standard for treatment, and the lack of definitive data makes it necessary to individualize its use in each patient.