Experience of the MALA Bag in the Open Abdomen Management in an Obstetrical Intensive Care Unit

Abstract

Introduction: Current indications for open abdomen management are damage control surgery, severe intra-abdominal sepsis, abdominal compartment syndrome, abdominal wall closure under tension and mass loss of the abdominal wall.Objective: To describe the experience in open abdomen management using the MALA (mayor absorción de líquido abdominal [greater absorption of abdominal liquid]) bag at the Maternal-Perinatal Hospital Mónica Pretelini Saénz, Health Institute of the State of Mexico.Material and Methods: This was a bidirectional, descriptive and observational study. All patients with the diagnosis of open abdomen managed with the MALA bag admitted to the Obstetric Intensive Care Unit from February 2009 to June 2012 were included.Results: From 25 cases identified in the period of the study, seven were eliminated for incomplete files, remaining 18 cases for the analysis. The mean age was 31.5 years. 78% of the patients were multigravidas, 50% of them with a history of 2 or more deliveries, 83% had a previous cesarean section and 78% were hysterectomized. Evisceration was present in one patient. The main indication for surgical management was damage control. One patient died and a second was transferred to another institution, the rest were discharged by clinical improvement. 12 patients (67%) spent less than 14 days in the Obstetric Intensive Care Unit, only one patient required morethan 30 days in the unit. Discussion: Halve the women who required this surgical alternative, were above 30 years of age. Stressing is the fact that from the 18 admitted patients, 14 (78%) had undergone obstetric hysterectomy, with the etiology of uterine atony in most cases. Damage control surgery seems to be the most elective surgical option to use MALA bag followed by ACS and abdominal sepsis.Conclusion: The MALA bag can offer an economic and effective surgical option for the open abdomen management as well as adrainage technique.

Report of a case of liver rupture in preeclampsia and HELLP syndrome

“…In the reported case, a damage control surgery protocol was made with six interventions in total, which were performed by the most trained personnel; however, there were some of the available options known in the literature, such as selective embolization, liver transplantation, interventional radiology measures, etc. [12][13][14][15][16][17] . However, due to the complications of concomitant preeclampsia, such as disseminated intravascular coagulation and the massive endothelial lesion developed, a series of events occurred that led to the need for multiple surgical reinterventions and with it the fearsome complication of intra-abdominal sepsis, which was finally the cause of her death, resulting similar to that described in multiple case reports and literature reviews cited [18][19][20] .…”

“…The treatment described for liver rupture goes from packing 12,13 , selective hepatectomy 14 , patch use with omentum 15 , selective embolization with interventional radiology 16 , and liver transplantation in extreme cases 17 generally, the combination of different techniques is more effective. Prognosis is variable, but usually fatal 18 with mortality of 60-70% of reported cases 19 .…”