Introduction/Background Damage control surgery (DCS) emerged as a feasible alternative for the management of patients with abdominal infection and sepsis in order to reduce mortality compared with primary definitive surgery.
The phases of DCS are defined by 5-steps: first, identifying injury characteristics and presenting pathophysiology, abbreviated surgery to control bleeding and contamination, dynamic reassessment of patient parameters during the operative course, continued physiological restoration and vital organ support in the intensive care unit (ICU) and finally, delayed definitive surgical repair.
Methodology We present a case of a 56 years-old woman with history of chronic hypertension and appendicectomy, with suspected ovarian mucinous carcinoma in context of a 25 cm right ovarian mass. Complete ovarian cytoreductive surgery was performed successfully including ileocecal resection with mechanical side-to-side anastomosis through midline laparotomy.
Results Five days after the intervention, the patient presented with septic shock secondary to acute peritonitis due to anastomotic leakage confirmed by urgent surgical evaluation with purulent peritonitis of the four quadrants.
During surgery the patient presented hemodynamic instability with high dose noradrenaline requirements and severe respiratory failure. Given the extreme severity DCS was performed, with excision of the previous ileocecal anastomosis, peritoneal lavage and placement of negative pressure therapy leaving open abdomen.
Subsequently, slow but favourable evolution occurred, performing reintervention at 48h for revision, terminal ileostomy and progressive closure of the abdominal wall according to the Leppäniemi technique until complete closure of the wall (2 more procedures). Finally, the patient was discharged 3 weeks after DCS with good general condition.
Conclusion There is insufficient evidence to advocate for DCS as a general strategy in patients with secondary peritonitis, but it may be an option in selected significantly physiologically deranged patients with ongoing sepsis.
DCS restores physiological reserve facilitating more definitive surgical treatment resulting in decreased perioperative complications and improved outcomes.
Disclosure Nothing to disclose.
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