Abstract
Introduction: As part of the damage control surgery concept applied to the treatment of sepsis due to severe secondary peritonitis following intestinal perforation and/or in high-risk patients we describe the novel "temporary intestinal shunt" (TIS) technique with delayed intestinal anastomosis, as an alternative to primary anastomosis or enterostomy.
 Material and Methods: We present three patients in whom urgent laparotomy was performed due to intestinal perforation, with intestinal resection and TIS.
 Case reports:Case 1: A 39-year-old male presented with acute myeloid leukemia M3 and generalized peritonitis, sigmoid colon perforation and secondary jejunal loop involvement. In view of these findings, we performed 10 cm jejunal resection with TIS placement, sigmoid colon resection, and negative pressure therapy (NPT). Reoperation after 48 hours showed no evidence of peritonitis, so a manual jejuno-jejunal anastomosis and terminal colostomy were performed. Case 2: A 65-year-old woman treated with corticosteroids presented with a pneumoperitoneum secondary to a road traffic accident. Urgent laparotomy revealed a 2 cm jejunal perforation. Resection of the jejunal segment and TIS with NPT was performed. Exploration of the peritoneal cavity 96 hours later showed clinical improvement and a jejuno-ileal anastomosis was performed. Case 3: A 73-year-old male was admitted due to intestinal subocclusion. Clinical deterioration occurred rapidly and we performed an urgent laparotomy diagnosing jejunal perforation secondary to torsion and ischemia of the affected loop, and generalized peritonitis. Intestinal resection and TIS with NPT placement were thus decided. Anastomosis and closure of the abdominal appendage were deferred until 96 hours after the first surgery. 
 Conclusion: Although the evidence we present is limited, we believe TIS to be an additional tool in damage control surgery. This staged management strategy allows definitive reconstruction with the patient in a more favorable physiological condition.
Highlights
S EVERE sepsis secondary to intrabdominal infection has bad prognosis with mortality rate that could exceed 30%,1–3 in patients with intestinal perforation.[4]
Conclusion: the evidence we present is limited, we believe temporary intestinal shunt" (TIS) to be an additional tool in damage control surgery
Leaving the abdomen open allows for the patient to be transferred to an intensive care unit (ICU) for the restoration of homeostasis followed by a return to the operation theatre 1 – 2 days later, when hemodynamic parameters have improved, for new surgical management with the definitive repair of organ defects.[5, 6]
Summary
S EVERE sepsis secondary to intrabdominal infection has bad prognosis with mortality rate that could exceed 30%,1–3 in patients with intestinal perforation.[4]. Various strategies have been proposed as abbreviated laparotomy, planned reoperation and recently, damage control surgery (DCS), in which an early temporizing operation is performed, leaving the abdomen open, followed by a planned reoperation with the definitive repair. The damage control approach allows abbreviated surgery for temporary control of the source of insult by the means of the "open abdomen" technique. Leaving the abdomen open allows for the patient to be transferred to an ICU for the restoration of homeostasis followed by a return to the operation theatre 1 – 2 days later, when hemodynamic parameters have improved (pH, blood pressure, diuresis), for new surgical management with the definitive repair of organ defects.[5, 6]
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