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Open Abdomen Improves Survival in Patients With Peritonitis Secondary to Acute Superior Mesenteric Artery Occlusion

Ding, Weiwei MD, PhD*; Wang, Kai MD*; Liu, Baochen MD*; Fan, Xinxin MD*,†; Wang, Shikai MD*; Cao, Jianmin MD; Wu, Xingjiang MD*; Li, Jieshou MD*

Journal of Clinical Gastroenterology: October 2017 - Volume 51 - Issue 9 - p e77–e82
doi: 10.1097/MCG.0000000000000799
ONLINE ARTICLE: Original Article

Background: Damage control surgery and open abdomen (OA) have been extensively used in the severe traumatic patients. However, there was little information when extended to a nontrauma setting. The purpose of this study was to evaluate whether the liberal use of OA as a damage control surgery adjunct improved the clinical outcome in acute superior mesenteric artery occlusion patients.

Study Design: A single-center, retrospective cohort review was performed in a national tertiary surgical referral center.

Results: Forty-four patients received OA (OA group) and 65 patients had a primary fascial closure (non-OA group) after diagnosed as peritonitis secondary to acute superior mesenteric artery occlusion from January, 2005 to June, 2016. Revascularization was achieved through endovascular aspiration embolectomy, open embolectomy, or percutaneous stent. No difference of bowel resection length was found between groups in the first emergency surgery. However, more non-OA patients (35.4%) required a second-look enterectomy to remove the residual bowel ischemia than OA patients (13.6%, P<0.05). OA was closed within a median of 7 days (4 to 15 d). There was a mean of 134 cm residual alive bowel in OA, whereas 96 cm in non-OA. More non-OA patients suffered from intra-abdominal sepsis (23.1% vs. 6.8%, P<0.01), intra-abdominal hypertension (31% vs. 0, P<0.01), and acute renal failure (53.8% vs. 31.8%, P<0.05) than OA group after surgery. Short-bowel syndrome occurred infrequently in OA than non-OA patients (9.1% vs. 36.9%, P<0.01). OA significantly decreased the 30-day (27.3% vs. 52.3%, P<0.01) and 1-year mortality rate (31.8 % vs. 61.5%, P<0.01) compared with non-OA group.

Conclusions: Liberal use of OA, as a damage control adjunct avoided the development of intra-abdominal hypertension, reduced sepsis-related complication, and improved the clinical outcomes in peritonitis secondary to acute SMA occlusion.

*Research Institute of General Surgery

Surgical Intensive Care Unit

Department of Radiology and Intervention Radiology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, Jiangsu Province, P.R. China

W.D. and K.W.contributed equally.

Supported by the National Natural Science Foundation of China (Grant No. 81300278, W.D.) and Natural Science Foundation of Jiangsu Province (Grant No. BK20130697, W.D.).

The authors declare that they have nothing to disclose.

Address correspondence to: Jieshou Li, MD, Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, P.R. China (e-mail:

Received July 27, 2016

Accepted December 5, 2016

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.