Abdominal compartment syndrome following Whipple operation
A 44 year old male developed low urine output, ARDS, and abdominal distention 6 hours after a Whipple operation for a duodenal tumor, which had eroded into the pancreas. A decompressive laparotomy was performed and the abdominal opening temporarily covered with a Bogota bag. After three days the Bogota bag was replaced with a Wittmann Patch sewn to opposing fascial edges. Over the course of three weeks the swelling subsided and the fascial edges were gradually brought closer by trimming and retightening the patch. When the fascial edges were close enough, the remaining patch material was removed and the abdominal wall formally closed.
Comment
The ability to simply peel open and re-close the patch without any suture removal or re-suturing steps saved a great deal of time and allowed for easy abdominal re-checks in the ICU. The ability to manage the pressure and at the same time keep a constant tension on the fascial edges prevented retraction and allowed for stepwise re-approximation as the swelling subsided. This allowed for a formal abdominal wall closure and avoidance of the hernia and repair that would have almost certainly followed.
Decompressive laparotomy.
Underside of the hook section of the patch sutured to fascial edge. The loop sheet rests over the bowel and is tucked under the opposing fascia.
Hook piece of patch trimmed to fit decreased size of abdominal opening. Adjustments are made to keep tension on fascial edges as the swelling decreases.
Abdominal wall closure three weeks later.
Case report courtesy of
Donn M. Schroder, MD, FACS
Assistant Program Director
St. John’s Hospital and Medical Center
Detroit, MI 48236