Laparostomy in a rural hospital: an African case report for a very important tool to be spread and increased

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Gian Domenico Arzu *
Riccardo Conventi
Giovanni Putoto
Emmanuel Onapa
(*) Corresponding Author:
Gian Domenico Arzu | argia01@gmail.com

Abstract

Laparostomy is a surgical technique enabling the surgeon to leave abdominal fascial edges opened after a laparotomy. This is a useful tool that can be very important in patients with intraabdominal hypertension. Open abdomen indications are: trauma, severe abdominal sepsis, intestinal infarction, vascular surgery and when the surgeon cannot close the abdomen due to high intra abdominal pressure in order to avoid abdominal compartment syndrome or in case of a second look in order to evaluate the conditions of the abdomen (and particularly of the gut). We used this technique in a low income country for a patient with intestinal obstruction where performing a primary anastomosis during the first operation was at high risk of leakage. A middle-aged woman was admitted in Pope John’s Hospital - Aber, Uganda for abdominal pain and intestinal obstruction (IO) symptoms. A laparotomy found a tract of small gut necrotic and twisted under a single adhesion. The small gut above the volvulus was dilated for the obstruction created by the adhesion. We decided to excise the necrotic intestine and leave the abdomen open for a second look and delayed anastomosis and closure. The managing of the IO was conducted by inserting a big Foley catheter in the proximal intestine to drain its enteric content in a similar fashion to a guided external fistula. Open abdomen is a very important technique, relatively new, that can impact positively in treating some surgical patients even in rural hospitals and in the absence of Intensive Care Unit. A simple trick can solve successfully the IO due to the volvulus. Laparostomy should be spread more in African and low-income countries.


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Author Biography

Gian Domenico Arzu, General Surgery, Doctors with Africa CUAMM, Padua

General Surgery