- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Part 6.1 Physiology
- Part 6.2 Gastrointestinal monitoring
- Part 6.3 Gastrointestinal haemorrhage
- Part 6.4 Disordered gastric motility
- Part 6.5 The acute abdomen in the ICU
- Chapter 184 Pathophysiology and management of raised intra-abdominal pressure in the critically ill
- Chapter 185 Perforated viscus in the critically ill
- Chapter 186 Ischaemic bowel in the critically ill
- Chapter 187 Intra-abdominal sepsis in the critically ill
- Chapter 188 Acute acalculous cholecystitis in the critically ill
- Chapter 189 Management of the open abdomen and abdominal fistulae in the critically ill
- Part 6.6 Pancreatitis
- Part 6.7 Jaundice
- Part 6.8 Acute hepatic failure
- Part 6.9 Acute on chronic hepatic failure
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care
(p. 889) Management of the open abdomen and abdominal fistulae in the critically ill
- Chapter:
- (p. 889) Management of the open abdomen and abdominal fistulae in the critically ill
- Author(s):
Philip Stevens
and Gordon Carlson
- DOI:
- 10.1093/med/9780199600830.003.0189
Management of the open abdomen and intestinal fistulae remains a significant challenge. Leaving the abdomen open when it is possible to close it confers no benefit and may increase morbidity. The abdomen may be left open as part of a ‘damage control’ strategy in an unstable patient with abdominal trauma, or in other conditions in which it may be impossible to close because swollen intestinal loops, retroperitoneal haematoma, or oedema may lead to abdominal compartment syndrome. It may also be inappropriate to close the abdomen when there has been infection that cannot be readily controlled. Intestinal fistulae are associated with considerable morbidity and mortality. Management is described by the four ‘R’s of resuscitation, restitution, reconstruction and rehabilitation. Eradication of sepsis, improved wound and skin care, safe nutritional support and appropriate timing of surgical intervention have reduced mortality related to enterocutaneous fistulae from 65 to <10% over the last 30 years. However, mortality from enteroatmospheric fistulae remains high. Fifty to eighty per cent of enterocutaneous fistulae close spontaneously, compared with only 10% of colonic fistulae. Refistulation rates are high despite operative repair.
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- Section 1 ICU organization and management
- Section 2 Pharmacotherapeutics
- Section 3 Resuscitation
- Section 4 The respiratory system
- Section 5 The cardiovascular system
- Section 6 The gastrointestinal system
- Part 6.1 Physiology
- Part 6.2 Gastrointestinal monitoring
- Part 6.3 Gastrointestinal haemorrhage
- Part 6.4 Disordered gastric motility
- Part 6.5 The acute abdomen in the ICU
- Chapter 184 Pathophysiology and management of raised intra-abdominal pressure in the critically ill
- Chapter 185 Perforated viscus in the critically ill
- Chapter 186 Ischaemic bowel in the critically ill
- Chapter 187 Intra-abdominal sepsis in the critically ill
- Chapter 188 Acute acalculous cholecystitis in the critically ill
- Chapter 189 Management of the open abdomen and abdominal fistulae in the critically ill
- Part 6.6 Pancreatitis
- Part 6.7 Jaundice
- Part 6.8 Acute hepatic failure
- Part 6.9 Acute on chronic hepatic failure
- Section 7 Nutrition
- Section 8 The renal system
- Section 9 The neurological system
- Section 10 The metabolic and endocrine systems
- Section 11 The haematological system
- Section 12 The skin and connective tissue
- Section 13 Infection
- Section 14 Inflammation
- Section 15 Poisoning
- Section 16 Trauma
- Section 17 Physical disorders
- Section 18 Pain and sedation
- Section 19 General surgical and obstetric intensive care
- Section 20 Specialized intensive care
- Section 21 Recovery from critical illness
- Section 22 End-of-life care