Bedside treatment of complex open abdomen

Ms Betty Brown1
1Royal Prince Alfred Hospital/Royal North Shore Hospital, Newtown, Australia

Care of a patient who had undergone 13 laparotomies for bowel obstruction and bowel perforation, with repeated failed attempts at ileostomy formation which resulted in multiple dehiscence and fistula formation.  He was transferred to our facility with short gut syndrome of ~ 150 cm bowel remaining, 4 perforations/fistulae, and grossly oedematous small bowel submerged in 2 litres of enteric bowel contents.

After debridement, Negative Pressure Wound Therapy (NPWT) was used with multiple contact layers to protect and separate the bowel.  After NPWT seal was obtained, fistula wound pouch was applied over the 4 fistulae to separate and monitor effluent. Dressings were changed 2-3 times weekly at the bedside with analgesia.

Patient developed complication of aggressive rare fungal infection within wound bed, treated with Veraflo therapy using hydrogen peroxide and aggressive serial surgical debridements.

Patient also had behavioural and family social issues which made his treatment and recovery challenging, and left against medical advice after 458 days of hospitalisation.

NPWT was continued until the wound was suitable for delayed primary closure and skin grafting.  He is now subsequently 95% healed and is now wearing a simple high output pouching system over his single fistula which had self-stomatised.


Biography:

Betty graduated with a Bachelor of Nursing on the Dean’s Honour list, from the University of Manitoba, Canada, in 2004.  She obtained her WOCNCB board certification in wound, ostomy, and continence nursing in the USA in 2010.  She has since worked as a wound and ostomy specialist nurse at top ranked hospitals including Johns Hopkins, Stanford University, Cleveland Clinic Abu Dhabi, Franciscan Health System, and  currently at Royal Prince Alfred Hospital and Royal North Shore Hospital in Sydney.  She has extensive experience in complex wound, ostomy, and fistula management, and is currently completing her Masters of Wound Care at Monash University, Victoria.