Open abdomen management and outcomes: two case reports from western Kenya and a review of literature from Africa

Abstract

The open abdomen (OA) is clinically indicated for attenuating the effects of select intra-abdominal insults that may lead to high intra-abdominal pressure with fascial closure. Despite the high incidence of conditions warranting OA in Africa, there are few reports on its use and outcomes. A retrospective chart review was performed for two patients managed with an OA at the Moi Teaching and Referral Hospital. For comparison, a literature review on related studies from Africa was performed. One patient had an anastomotic leak, while the other had a perforated gastric ulcer. A Bogotá bag was used for temporary abdominal content containment. There was no mortality in our series and fascial closure was achieved in one patient. Upon review of studies from Africa, overall mortality stood at 44%, while 25% of surviving patients underwent fascial closure. The use of OA in Africa is associated with high mortality and low rates of fascial closure. Our limited experience shows this technique is a viable treatment option in an attempt to bridge a patient to abdominal closure during critical illness.

Manejo actual del abdomen abierto

“…A las 48 horas se llevo a cabo una nueva laparotomía que permitió identificar la indemnidad de la reparación a nivel gástrico y reducción del edema intestinal, por tanto, se realizó síntesis fascial de manera exitosa, con egreso a los 10 días de evolución intrahospitalaria. Tales resultados discrepan de los registrados en África, donde el abdomen abierto se asocia con elevadas tasas de mortalidad y exiguos casos de cierre fascial adecuado, sin embargo, debe considerarse que la tasa de éxito del abdomen abierto se ve modificada por el grado de lesión abdominal, por lo que los autores apuntalan que es fundamental que se realicen estudios longitudinales que permitan comprender los beneficios de esta técnica así como los efectos que conlleva en la calidad de vida de los pacientes (Mwita et al, 2019).…”