PERITONEOSTOMY WITH ADOPTION OF NEGATIVE PRESSURE THERAPY: A CASE REPORT (Atena Editora)

Abstract

Introduction: The management of traumatized patients or those with severe intra-abdominal infections presented a difficult problem to solve: the primary closure without tension of the abdominal cavity. On the other hand, advances in patient care brought significant gains in survival, with the increase and improvement of peritonetostomies. Peritoneostomy consists of an operative strategy, in which the abdominal cavity is left open and the planes of the abdominal wall are not completely approximated, allowing a regular inspection of the condition of the loops and drainage of intra-cavity content, reducing the need for transfer of the patient to the operating room, minimizing the cumulative risks of multiple transports and anesthesia. Goal: The purpose of this study is to analyze the use of negative pressure (vacuum) therapy as a proposal for temporary coverage and control of peritonitis in patients undergoing damage control laparotomy, based on the use of negative pressure therapy, associated or not with polypropylene screen with scheduled washes every 72 hours, or demand as indicated by the patient's clinical condition. Technique: Isolation of the intestinal loops from the edges of the wall that are involved by a sterile multiperforated polyethylene film with scissors or a scalpel blade between the abdominal viscera and the anterior parietal peritoneum, surgical compresses on the sheet with two suction drains and covered with an iodine-impregnated polyester adhesive plastic bonded to the skin including a wide margin of surrounding skin. The drains are then connected to a suction device that can provide 100-150 mmHg of continuous negative pressure. Clinical case: A 65-year-old male patient came to the emergency room with abdominal pain in a band with sweating and fever that had not been measured and hematochezia, with a 3-day course. On physical examination, he was pale, with a distended and painful abdomen on diffuse palpation, with signs of peritoneal irritation. An abdominal X-ray was performed, which showed bilateral pneumoperitoneum. He underwent exploratory laparotomy, identifying a distal rectal laceration and a distal Hartmann hemicolectomy with burial of the rectal stump in two planes and an end colostomy. In the postoperative period, he evolved with surgical wound infection by multidrug-resistant bacteria, and was then submitted to laparotomy revision: peritoneostomy with Bogotá bag fixation. Due to the accumulation of secretion in the abdominal cavity, it was necessary to perform a vacuum dressing as a therapeutic resource. Conclusion: The vacuum dressing proved to be a good option for temporary coverage of peritoneostomies, allowing faster closure of the abdominal wound, reducing the number of reoperations and promoting protection of loops against bacterial contamination.