VAC therapy with long term continuous saline infusion for secondary septic peritonitis: A new strategy for the reduction of perioperative risks?

Highlights • The use of VAC therapy is amply demonstrated in the literature as an adjuvant in the open abdomen technique. • Today VAC therapy have not a definite indication in secondary septic peritonitis. • In our case, VAC therapy wasn’t a rescue treatment, but a preventive treatment of high-risk perioperative complications. • A conservative approach led to the resolution of the septic shock and to the wound healing.
Background The management of a septic peritonitis open abdomen is a serious problem for clinicians. Open surgery is associated with several complications such as bleeding and perforation of the bowel. Case presentation The authors report a case of a 59-years-old female who underwent a sigmoid resection with an latero-terminal (L-T) anastomosis for the perforation of a diverticulum. After a few days the patients developed a new widespread peritonitis. At the emergency re-laparotomy, surgeons found dehiscence of the posterior wall of the anastomosis with fecal contamination. At admission in ICU (Intensive Care Unit) the patient had open abdomen with dehiscence of cutaneous and subcutaneous layers. Conclusion Conservative therapy with antibiotic therapy and use of the Vacuum-Assisted Closure® (VAC) Therapy with a long term continuous saline infusion led to the resolution of the septic shock and to the wound healing.