Aim
To present the complexity of the treatment of abdominal compartment syndrome (ACS) caused by acute pancreatitis. This challenging condition needs a complex surgical and intensive care approach.
Methods
The authors report a case of a 47-year-old male patient who developed severe acute pancreatitis and subsequently ACS, showing rapidly increasing intra-abdominal pressure values, which needed surgical decompression. After the decompressive laparotomy the VivanoMed Abdominal kit was inserted in the abdomen, a negative pressure of 100 mmHg was set up. The Abdominal Kit was changed every 3-5 days.
Results
At the beginning of the treatment up to 4000 ml exudate per day was evacuated from the abdominal cavity, which started to decrease after a few days. After 4 weeks of the onset of the pancreatitis - during the open abdomen treatment - the pancreas became infected, and the necrosectomy was performed, together with a subtotal colectomy, which was necessary because of an extensive damage of the colon.
The closure of the abdominal wall was possible by component separation, combined with NPWT. After 3 changes of the NPWT dressing closure of the skin was possible, and an incisional NPWT dressing was used for another 5 days. The wound healed without complication. The pancreatitis healed, no more operations were needed. Unfortunately the patient died suddenly because of a malignant cardiac arrhythmia, 2 days before the planned emission from the hospital.
Conclusion
When abdominal decompression surgery is needed during ACS, NPWT is a good tool in the hands of the surgeon, making complex wound and exudate management possible during the treatment.
Clinical relevance
Management of the open abdomen, as well as the closure of the abdominal wall after abdominal NPWT can be challenging. Deep knowledge of the different types of NPWT possibilities is recommended for surgeons who treat patients with acute pancreatitis.
