Bjorck et al developed a classification for a patient with an open abdomen. The goal is to improve communication and management by standardizing terminology. The authors are from multiple institutions in Europe and the United States.
Patient selection: open abdomen
Pathways to an open abdomen include:
(1) peritonitis with need for follow-up examinations
(2) tense abdomen at risk for the abdominal compartment syndrome following surgery or resuscitation
(3) damage control
(4) primary of secondary abdominal compartment syndrome
Parameters:
(1) adhesions and/or fixity
(2) fistula
(3) clean versus contaminated
Adhesions and/or Fixity
Fistula
Contamination
Grade
none
none
absent (clean)
1A
none
none
present
1B
developing
none
absent
2A
developing
none
present
2B
present but not frozen
present
NA
3
frozen and unable to close surgically
NA
NA
4
Goals of management:
(1) minimize adhesions
(2) avoid lateralization of the abdominal wall
(3) avoid infection
(4) avoid fistula
(5) avoid the abdominal compartment
(6) achieve primary delayed fascial closure
(7) achieve normal bowel function without obstruction
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