Systemic peritoneal cavity lavage: a new strategy for treatment of the open septic abdomen

Management of the open abdomen is a challenge, certainly when fistulisation is present. This paper presents a new treatment modality for this specific situation.

Abdominal sepsis increases the net flow across the peritoneum to 300-500 ml/h. This flow was used to clean and flush the abdomen. Meropenem was administered, as antibiotic concentration in the peritoneal cavity is known to reach therapeutic levels after 8 hours. The abdominal fluid was captured using the abdominal VAC system and additional drains. The total amount of drained fluid was compensated intravenously. Thus, the concept was named "Systemic Peritoneal Cavity Lavage" (SPCL).

Four patients with an open abdomen and severe abdominal sepsis were treated with SPCL and got out of their septic state within two weeks despite fistulisation and ongoing bowel leakage in three patients. A partial enterectomy with removal of the fistulas could be performed six weeks later.

SPCL is a promising method to treat patients with severe abdominal sepsis. In combination with the fistula isolation technique it permits delayed treatment of fistulas in a hostile abdomen where immediate removal of the septic focus is impossible.