Alginate Pack Dressing to Treat Complete Burst Abdomen · 2017-09-18 · Eltair M (2017) Alginate...
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Central Bringing Excellence in Open Access JSM General Surgery: Cases and Images Cite this article: Eltair M (2017) Alginate Pack Dressing to Treat Complete Burst Abdomen. JSM Gen Surg Cases Images 2(4): 1038. *Corresponding author Eltair M, Colorectal Registrar Sandwell hospital, West Bromwish, UK, Email: Submitted: 05 July 2017 Accepted: 12 September 2017 Published: 18 September 2017 Copyright © 2017 Eltair ISSN: 2573-1564 OPEN ACCESS Case Report Alginate Pack Dressing to Treat Complete Burst Abdomen Eltair M* Colorectal Registrar Sandwell hospital, UK INTRODUCTION Burst abdomen is a postoperative complication associated with significant morbidity and mortality. The risk factors for burst abdomen are patient and surgery related. The management of this complication is a relatively unexplored area within the field of surgery. Relevant surgical outcomes include recurrence, mortality, and incisional hernia. Reported conservative management options included use of saline-soaked gauze dressings and negative pressure wound therapy. Operative management options included temporary closure options (open abdomen treatment), primary closure with various suture techniques, closure with application of relaxing incisions, use of synthetic (non absorbable and absorbable) and biological meshes and the use of tissue flaps. The treatment of burst abdomen is associated with unsatisfactory surgical outcome [1,2]. CASE PRESENTATION 48 years old Male patient, known Crohn’s disease treated in the past with Azathioprine and Prednisolone, was admitted initially under medics with shortness of breath, anorexia and diarrhoea about ten times a day. Bloods on admission showed White cell count (WCC) of 15.3, C-reactive proteins (CRP) of 17 and a Haemoglobin (Hb) of 61 for which he had 3 units of blood transfusion. One week later, the patient spiked a temperature of 39.6,Computerized Tomography (CT) of abdomen and pelvis showed sigmoid and rectal thickening hence antibiotic was started, flexible sigmoidoscopy was done which confirmed severe inflammation of the rectum and sigmoid from which biopsies were taken. This inflammation did not settle down over a week as manifested with persistentrise in temperature and CRP reaching 243 which prompted the surgeon to perform laparoscopic colectomy and terminal ileostomy. Postoperatively, the recovery was slow as the patient continued to spike temperature, developed ileus. Day 4 postoperative, with rising CRP 403 and WCC 15.9, a CT abdomen was done which showed surgical emphysema but no intra-abdominal collection thus conservative treatment continued. Two days later, the patient was started on TPN as ileus remained but luckily thereafter the patient started to improve as his stoma moved and temperature settled. Unfortunately, day 9 postoperatively the patient was found to have developed wound infection which progressed to a complete burst abdomen (Figure 1). The on call consultant decided to manage the wound dehiscence conservatively using alginate dressing pack (KALTOSTAT) as the wound was infected and was not deemed to hold the sutures for closure and thus the plan was to try to convert the wound to an incisional hernia manageable in the future. The patient settled, granulation tissue was building up nicely in the wound and the patient was discharged three days later with the plan to follow up the wound in the outpatient in two weeks time. The patient was seen in hospital two weeks later, the wound was improving, becoming almost superficial (Figure 2) thus left to be closed by secondary intention later. LEARNING POINT Complete burst abdomen when infected can be managed conservatively using Alginate dressing (e.g KALTOSTAT, SORBOSAN…) with good result converting it to incisional hernia to be dealt with electively rather than closing abdomen with sutures which can give way due to infected oedematous tissue. Table 1: Abbreviations and normal levels glossary. Abbreviations Normal levels WCC: white cell count 4.0-11.0 10*9/L CRP: C-reactive protein <1 mg/L Hb: Haemoglobin 120-180 g/L CT: Computerized tomography Figure 1 Complete burst abdomen showing bowel at the base of the wound about 6 cm length with covering infected granulation tissue and gaping fascia stitches.
Transcript of Alginate Pack Dressing to Treat Complete Burst Abdomen · 2017-09-18 · Eltair M (2017) Alginate...
CentralBringing Excellence in Open Access
JSM General Surgery: Cases and Images
Cite this article: Eltair M (2017) Alginate Pack Dressing to Treat Complete Burst Abdomen. JSM Gen Surg Cases Images 2(4): 1038.
*Corresponding authorEltair M, Colorectal Registrar Sandwell hospital, West Bromwish, UK, Email:
Submitted: 05 July 2017
Accepted: 12 September 2017
Published: 18 September 2017
Copyright© 2017 Eltair
ISSN: 2573-1564
OPEN ACCESS
Case Report
Alginate Pack Dressing to Treat Complete Burst AbdomenEltair M*Colorectal Registrar Sandwell hospital, UK
INTRODUCTIONBurst abdomen is a postoperative complication associated
with significant morbidity and mortality. The risk factors for burst abdomen are patient and surgery related. The management of this complication is a relatively unexplored area within the field of surgery. Relevant surgical outcomes include recurrence, mortality, and incisional hernia. Reported conservative management options included use of saline-soaked gauze dressings and negative pressure wound therapy. Operative management options included temporary closure options (open abdomen treatment), primary closure with various suture techniques, closure with application of relaxing incisions, use of synthetic (non absorbable and absorbable) and biological meshes and the use of tissue flaps. The treatment of burst abdomen is associated with unsatisfactory surgical outcome [1,2].
CASE PRESENTATION48 years old Male patient, known Crohn’s disease treated
in the past with Azathioprine and Prednisolone, was admitted initially under medics with shortness of breath, anorexia and diarrhoea about ten times a day. Bloods on admission showed White cell count (WCC) of 15.3, C-reactive proteins (CRP) of 17 and a Haemoglobin (Hb) of 61 for which he had 3 units of blood transfusion. One week later, the patient spiked a temperature of 39.6,Computerized Tomography (CT) of abdomen and pelvis showed sigmoid and rectal thickening hence antibiotic was started, flexible sigmoidoscopy was done which confirmed severe inflammation of the rectum and sigmoid from which biopsies were taken. This inflammation did not settle down over a week as manifested with persistentrise in temperature and CRP reaching 243 which prompted the surgeon to perform laparoscopic colectomy and terminal ileostomy. Postoperatively, the recovery was slow as the patient continued to spike temperature, developed ileus. Day 4 postoperative, with rising CRP 403 and WCC 15.9, a CT abdomen was done which showed surgical emphysema but no intra-abdominal collection thus conservative treatment continued. Two days later, the patient was started on TPN as ileus remained but luckily thereafter the patient started to improve as his stoma moved and temperature settled. Unfortunately, day 9 postoperatively the patient was found to have developed wound infection which progressed to a complete burst abdomen (Figure 1). The on call consultant
decided to manage the wound dehiscence conservatively using alginate dressing pack (KALTOSTAT) as the wound was infected and was not deemed to hold the sutures for closure and thus the plan was to try to convert the wound to an incisional hernia manageable in the future. The patient settled, granulation tissue was building up nicely in the wound and the patient was discharged three days later with the plan to follow up the wound in the outpatient in two weeks time. The patient was seen in hospital two weeks later, the wound was improving, becoming almost superficial (Figure 2) thus left to be closed by secondary intention later.
LEARNING POINTComplete burst abdomen when infected can be managed
conservatively using Alginate dressing (e.g KALTOSTAT, SORBOSAN…) with good result converting it to incisional hernia to be dealt with electively rather than closing abdomen with sutures which can give way due to infected oedematous tissue.
Table 1: Abbreviations and normal levels glossary.
Abbreviations Normal levels
WCC: white cell count 4.0-11.0 10*9/L
CRP: C-reactive protein <1 mg/L
Hb: Haemoglobin 120-180 g/L
CT: Computerized tomography
Figure 1 Complete burst abdomen showing bowel at the base of the wound about 6 cm length with covering infected granulation tissue and gaping fascia stitches.
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JSM Gen Surg Cases Images 2(4): 1038 (2017) 2/2
Eltair M (2017) Alginate Pack Dressing to Treat Complete Burst Abdomen. JSM Gen Surg Cases Images 2(4): 1038.
Cite this article
REFERENCES1. Van Ramshorst GH, Eker HH, Harlaar JJ, Nijens KJ, Jeekel J, Lange JF.
Therapeutic alternatives for burst abdomen. Surg Technol Int. 2010; 19: 111-119.
2. Qaiyoume Amini A, Naveed AK, Ahmad J, Siraj Memon A. Management of abdominal wound dehiscence: still achallenge. Pak J Surg. 2013; 29: 84-87.
Figure 2 Two weeks later, showing the wound healing after use of Kaltosat dressing with healthy granulation tissue.
