P-051 OPEN ABDOMEN MANAGEMENT IN PATIENT WITH ECMO THERAPY

Abstract

Abstract Management of negative pressure therapy with fascial traction mediated by inlay mesh, in the context of a patient with multiple organ failure (MOF) secondary to sepsis of abdominal origin in treatment with extracorporeal membrane oxygenation therapy (ECMO) We present the case of a 15-year-old female patient, referred to a hospital after continuous consultations in a primary care center. She refers abdominal pain located in the right iliac fossa of 72 hours of evolution. Blood analysis with high infectious parameters, abdomen on a table and scanner compatible with acute appendicitis complicated by perforation. Urgent surgical intervention, where purulent peritonitis was observed in the four quadrants, the abdomen was kept open with NPT. In a situation of MOF, the need for high-dose noradrenaline and acute respiratory failure. During intubation, 2nd pneumothorax due to barotrauma. Given early deterioration, ECMO therapy was started. After completion of treatment, decreased intra-abdominal pressure and no restrictive respiratory compromise. Progressive fascial traction, using inlay mesh for 18 days until complete closure, using 2/0 monofilament suture, small bites technique, 4:1 ratio and placement of wide-pore, onlay polypropylene mesh. Partial dehiscence of the surgical wound as the only complication, NPT at 80mm Hg with definitive closure was prescribed. Satisfactory evolution one year after the intervention. After our experience with this case, we can conclude that NTP in the open abdomen with the help of facial traction mesh, in patients with ECMO therapy in a situation of septic shock, may be an adequate alternative for definitive closure of the abdominal wall.