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

Abstract

Introduction: Peptic ulcer perforation is a common surgical emergency that is a complication of 9% of patients with peptic ulcer disease (Kjetil et al., 2015 [1]). Despite advances in the management of peptic ulcer disease, the number of acute complications have remained constant. Intra-abdominal sepsis is defined as inflammation of the peritoneum caused by pathogenic micro-organisms and their products (Pavlidis, 2003).

Case presentation: We present a case report on intra-abdominal sepsis in a 20 yr old patient admitted in the intensive care unit at our institution following a perforated duodenal ulcer that was repaired by modified Graham patch method but leaked and he had multiple surgeries thereafter necessitating the open abdomen.

Discussion: The open abdomen remains an option to the surgeon as the patient may have severe peritonitis or be in septic shock. Hence the need of damage control laparotomy due to severe physiological derangement or a planned second look laparotomy if there is failed source control.

Conclusion: Intra-abdominal sepsis management of patient in an intensive care unit set-up with adequate surgery, open abdomen treatment and antibiotics given based on blood culture and sensitivity results enables successful management of difficult surgical abdomens.

Keywords: Intra-abdominal sepsis; Multiple abdominal surgeries; Open abdomen; Peptic ulcer disease; Peritonitis.