THE USE OF DAMAGE CONTROL SURGERY AND DIRECT PERITONEAL RESUSCITATION IN THE MANAGEMENT OF INTRAABDOMINAL INJURY SECONDARY TO ABDOMINAL TRAUMA: A CASE SERIES eunicesanmd@gmail.com

 

THE USE OF DAMAGE CONTROL SURGERY AND DIRECT PERITONEAL RESUSCITATION IN THE MANAGEMENT OF INTRAABDOMINAL INJURY SECONDARY TO ABDOMINAL TRAUMA: A CASE SERIES

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Philippines

Oral or Poster

Severe abdominal trauma is often complicated by the lethal triad of metabolic acidosis, hypothermia, and coagulopathy, necessitating immediate and strategic intervention. Damage control surgery (DCS) prioritizes physiological stabilization before definitive repair, while direct peritoneal resuscitation (DPR) enhances organ perfusion and modulates inflammation.

This case series, conducted in September 2024, included an 18-year-old male with a grade IV blunt liver injury sustained in a motor vehicle collision and a patient with a gunshot wound, resulting in a grade II duodenal injury, a grade IV liver injury, and a grade I right renal injury. Both patients underwent staged DCS with adjunctive DPR by placing suction catheters on the lateral sides of the superior part of the laparotomy wound and a Jackson-Pratt drain in the left lower quadrant. The suction catheters facilitate continuous wall suction, while the Jackson-Pratt drain is connected to a 2.5% peritoneal dialysate solution. The abdomen is temporarily closed using an improvised vacuum-assisted closure device, consisting of two connected urine bags, visceral packs, and an adherent dressing.

Both patients underwent emergent laparotomy. The first patient necessitated additional DCS with DPR due to uncontrolled liver hemorrhage and bowel edema. The second patient underwent primary duodenal repair, liver packing, and DCS with DPR. Upon re-evaluation, liver hemorrhage was controlled, and no duodenal leakage was observed, allowing for abdominal closure.

This case series highlights the clinical utility of integrating DPR into DCS protocols and underscores the need for further research to optimize its role in trauma management.