Evaluation of Risk Factors for Enteric Fistula and Intra-abdominal Sepsis in Patients with Open Abdomen in Trauma—a Level 1 Trauma Centre Study

Abstract

Open abdomen or laparostomy as a method of damage control in emergency surgery especially with perforated viscus has been used mainly to prevent abdominal compartment syndrome, burst abdomen and delayed ventral hernia. The authors aimed to study the associated morbidity of open abdomen with clinical and resuscitative parameters. A historical cohort of patients with open abdomen after emergency laparotomy at Trauma Centre AIIMS, New Delhi, from January 2013 to December 2017 was included in this analysis. Patients operated elsewhere came to this hospital for further care; patients with AIS (abbreviated injury score) > 3 in other body regions and patients who died within 48 h were excluded. These patients were studied for their requirement of more than usual post-operative care in the form of requirement of resuscitative measures and other vital clinical parameters. A comparative analysis of patients with and without intra-abdominal complications (enteric fistula and intra-abdominal sepsis) was performed. Of the 113 subjects studied from historical case records, 52 had intra-abdominal sepsis and 10 had entero-cutaneous fistulae. These patients in comparison with those who did not undergo laparotomy during the same period did not require extra efforts for resuscitation, ICU care, increased hospital stay, chest infection and other clinical and biochemical morbid parameters. Immediate post-operative period in this cohort of patients with open abdomen was not associated with extra effort to resuscitate or burden on clinical work. Early definitive closure of abdomen is recommended once patients are stabilised to avoid laparostomy-related complications.