213 Utility of Botox Injection in Early Laparostomy Closure for Abdominal Compartment Syndrome in Acute Severe Pancreatitis – a Case Report

Abstract

Abstract Acute pancreatitis can cause significant visceral oedema due to fluid resuscitation, paralytic ileus and ascites with raised intra-abdominal pressure(IAP) and abdominal compartment syndrome (ACS >20mmHg). Failure of conservative management is an indication for decompressive laparostomy. Early fascial closure is the priority following laparostomy to reduce morbidity, mortality, and the risk of enteric fistulation. Chemical component separation with Botulinum toxin injection is proven to be of benefit prior to elective complex ventral hernia repairs and has been reported in laparostomy closure. We report our use of Botox to assist with vacuum and mesh-assisted early closure of laparostomy in a patient with acute severe pancreatitis. A 29-year-old male was admitted with severe alcohol induced pancreatitis. He developed acute respiratory distress and was intubated and ventilated. On day 14 of admission, he developed raised IAP of >40mmHg with multiorgan dysfunction and underwent laparostomy and application of Abthera© vacuum assisted negative pressure dressing. 3 days later, the dressing was replaced and a prolene mesh was sutured to the fascial margins to allow approximation of the wound to prevent retraction of the rectus sheath. He underwent further dressing change with trimming of mesh on day 6 and received 300U of Botulinum toxin injection into the abdominal musculature bilaterally. On day 7 following botox injection, the mesh was excised, and the midline wound was closed without tension. He remained stable with normal IAP and no wound related complications. Chemical component separation with Botulinum toxin may be a valuable adjunct in early closure of laparostomy.