Rezende-Neto et al identified categories for why a patient was left with an open abdomen after a damage control surgery. The authors are from the University of Toronto and Federal University of Minas Gerais in Brazil.

Patient selection: surgical patient left with an open abdomen with temporary abdominal closure



(1) anatomical

(2) physiological

(3) logistical


Anatomical reasons:

(1) inability to approximate the edges of the laparotomy and perform primary closure

(2) soft tissue loss

(3) impending risk of abdominal compartment syndrome

(4) abdominal organ distention/edema/swelling


Physiological reasons:

(1) elevated serum lactate concentration (> 5 mmol/L)

(2) lower arterial pH (< 7.2)

(3) systolic blood pressure < 90 mm Hg


Logistical reasons:

(1) bowel left in discontinuity

(2) intra-operative packing

(3) planned re-operation

(4) other reasons for serial surgical interventions necessary

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