Challenges and Management of Open Abdomen in Resource-limited Settings: A Case Report of a Morbidly Obese Patient with Mesenteric Panniculitis
Dharanindra Moturu
*
Critical Care Physician and Incharge Medical ICU, Aster Ramesh Hospital, Vijayawada, Andhra Pradesh, India.
Sri Venkata Pavaneswar Velineni
Gastro Surgeon at Aster Ramesh Hospital, Vijayawada, Andhra Pradesh, India.
V Dinesh Kumar Gontla
Critical Care Medicine, Aster Ramesh Hospital, Vijayawada, Andhra Pradesh, India.
Supriya Rayana
Department of Pharmacy Practice, KL College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Guntur, Andhra Pradesh, India.
Ramesh Yelanati
Aster Ramesh Hospital, Vijayawada, Andhra Pradesh, India.
Kavya Sruthi Grandhi
KL College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Guntur, Andhra Pradesh, India.
Naga Suvarna Maddu
KL College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Guntur, Andhra Pradesh, India.
Shaik Mohammad Noor
KL College of Pharmacy, Koneru Lakshmaiah Education Foundation, Vaddeswaram, Guntur, Andhra Pradesh, India.
Kalikrishna Varaprasad Movva
Trainee ICU, Royal Prince Alfred Hospital, Sydney, Australia.
*Author to whom correspondence should be addressed.
Abstract
Management of the open abdomen in a resource-limited settings is challenging but essential, especially in abdominal sepsis and trauma, where timely fascial closure significantly impacts outcomes. We present the case of a 52-year-old morbidly obese female diagnosed with mesenteric panniculitis due to a sealed-off ileal perforation who underwent exploratory laparotomy. Due to severe inflammation and the inability to achieve primary abdominal closure, temporary coverage was innovatively performed using a sterile urobag. Managed with restrictive fluid therapy, total parenteral nutrition, and strict infection control measures in an intensive care environment, the patient subsequently underwent staged abdominal closure with the ABTHERA vac system. Successful fascial closure was achieved by postoperative day 6, with the patient progressing effectively to enteral nutrition and being discharged without significant complications. This case underscores the importance of managing complex open abdomen scenarios even in settings with limited resources through meticulous perioperative strategies and creative solutions.
Keywords: ABTHERA open abdomen manager vac system, ICU management, Mesenteric panniculitis, open abdomen