Intra- abdominal sepsis from a perforated duodenal ulcer-Management of a difficult surgical abdomen

Area of Science:

• Surgical Emergency
• Critical Care Medicine

Background:

• Peptic ulcer perforation is a frequent surgical emergency, complicating 9% of peptic ulcer disease cases.
• Despite advancements, acute peptic ulcer complications remain constant, with intra-abdominal sepsis posing a significant threat.
• Intra-abdominal sepsis involves peritoneal inflammation due to microorganisms and their toxins.

Purpose of the Study:

• To present a case of intra-abdominal sepsis in a young patient following a perforated duodenal ulcer.
• To highlight the management challenges and surgical interventions required for complex cases.

Main Methods:

• Case report of a 20-year-old patient with a perforated duodenal ulcer.
• Initial repair with modified Graham patch, followed by leakage and multiple surgeries.
• Necessitated an open abdomen approach due to persistent complications.

Main Results:

• The patient required multiple surgeries after initial repair failure.
• An open abdomen strategy was ultimately employed to manage the severe condition.
• Successful management was achieved through intensive care, surgery, and tailored antibiotics.

Conclusions:

• The open abdomen is a viable surgical option for patients with severe peritonitis or septic shock.
• Damage control laparotomy or planned second-look laparotomy may be necessary for failed source control.
• Comprehensive management involving surgery, open abdomen treatment, and culture-guided antibiotics is crucial for difficult surgical abdomens.