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SURGICAL APPROACH IN PATIENTS WITH CATASTROPHIC
ABDOMEN: CHALLENGES AND INNOVATIONS
Pedro Moura Carias1
Evelyn Almeida do Nascimento2
Matheus Almeida Cabral dos Santos Lugão3
João Pedro Rocha Morozini4
Pedro Henrique Braga5
Rebeca Leite Bicalho6
Carolina Garcia Lima7
Ana Luiza Cerutti Dutra8
Evelyn Fernanda Santos9
Júlia Bandeira Lima10
Maycon Costa Pignaton11
Amanda Stein de Siqueira Varejão12
Camile Ventorim Giurizatto13
Maria Carolina de Oliveira Gomes14
1 EMESCAM
2 Vila Velha University
3 EMESCAM
4 EMESCAM
5 Vila Velha University
6 Vila Velha University
7 UNIG Itaperuna
8 Multivix Faculty Vitória
9 Universidade do Estado da Bahia
10 Vila Velha University
11 University Center of Espírito Santo
12 Vila Velha University
13 Vila Velha University
14 University Center of Espírito Santo
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Isadora Agrizzi Morais15
Abstract: Catastrophic abdomen, characterized by severe abdominal dysfunction due to trauma,
infection or surgical complications, represents one of the greatest challenges in emergency surgery. The
condition requires rapid and eective interventions, given the high mortality rate and the signicant
impact on the quality of life of surviving patients. The aim of this study is to analyze the challenges
faced in the surgical approach to catastrophic abdomen and to explore the technical and technological
innovations that have contributed to improving clinical outcomes. This is a literature review with a
qualitative approach, using the PubMed, Scopus and Web of Science databases. To ensure accuracy in
the selection of studies, health descriptors (DeCS/MeSH) such as “Intra-abdominal Infections,” “Sepsis
Management,” and “Abdominal Compartment Syndrome” were used. The search was carried out using
Boolean operators, covering the period from 2019 to 2021, according to the time frame of the selected
references. The surgical management of catastrophic abdomen requires a multidisciplinary approach,
with an initial focus on damage control to stabilize the patient. Techniques such as laparostomy with
progressive traction closure and the use of negative pressure therapy have proven eective in managing
abdominal compartment syndrome, a common complication. In addition, advances in hemodynamic
monitoring and the use of biomaterials for abdominal wall reconstruction have allowed for greater
safety in denitive surgeries. Among the main challenges are the control of resistant intra-abdominal
infections, the hemodynamic fragility of patients and the need for prolonged intensive care in the post-
operative period. Therefore, the surgical approach to the catastrophic abdomen has evolved signicantly
with the development of modern techniques and advanced technologies. However, the complexity of the
clinical picture requires specialized training and well-established protocols to optimize outcomes. The
integration of innovative strategies and a focus on individualized care are fundamental to reducing the
morbidity and mortality associated with this critical condition.
15 University Center of Espírito Santo
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Keywords: General Surgery; Catastrophic Abdomen; Abdominal Surgery.
INTRODUCTION
Catastrophic abdomen is a complex and highly severe clinical condition, characterized by
multiple abdominal organ failure secondary to severe inammatory, infectious, or traumatic processes.
This syndrome is often associated with high mortality and severe complications, requiring quick and
eective surgical interventions. Studies indicate that the initial approach and correct management
of these patients are determinant for survival and functional recovery, highlighting the need for
well-structured protocols and technological innovation to improve surgical outcomes (Levy et al.,
2021).
Challenges faced in treating catastrophic abdomen include controlling sepsis, preserving
organ viability, and managing the severe physiological changes associated with the syndrome. The
concept of damage control surgery has gained prominence as a central strategy in the management
of this condition. This method, which prioritizes initial damage containment followed by denitive
surgical interventions in stages, has been shown to be eective in reducing complications and
improving patient survival (Sartelli et al., 2019).
In recent years, the introduction of new technologies and innovative approaches, such as
the use of vacuum therapy for temporary closure of the abdomen, has expanded the possibilities of
treatment. These innovations, combined with the use of biomarkers for monitoring the inammatory
response and advanced hemodynamic support techniques, have transformed the landscape of
catastrophic abdomen management, enabling more precise and personalized interventions (De Waele
et al., 2020).
In addition, multidisciplinary training and the integration of specialized teams are essential
to deal with the complexity of this situation. The literature points out that the joint work of trained
surgeons, intensivists, and nurses signicantly increases the chance of therapeutic success, especially
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in intensive care settings (Blanco et al., 2021). Thus, the study of the catastrophic abdomen requires
a comprehensive view, considering not only the technical advances, but also the human and logistical
particularities that involve the approach to this critical scenario.
The objective of this study is to analyze the challenges faced in the surgical approach to the
catastrophic abdomen and to explore the technical and technological innovations that have contributed
to improving clinical outcomes.
MATERIALS AND METHODS
This is a literature review, with a qualitative approach, using the PubMed, Scopus and
Web of Science databases. To ensure accuracy in the selection of studies, health descriptors (DeCS/
MeSH) such as “Intra-abdominal Infections,” “Sepsis Management,” and “Abdominal Compartment
Syndrome” were used. The search was carried out with the application of Boolean operators, covering
the period from 2019 to 2021, according to the time frame of the selected references.
1. Guiding Question:
What are the evidence-based best practices for the management of severe intra-abdominal
infections and associated conditions, such as abdominal compartment syndrome and sepsis, in
critically ill patients?
Inclusion Criteria:
- Publications between the years 2019 and 2021;
- Peer-reviewed articles available in full text;
- Studies involving adult patients in critical settings;
- Works published in English or Portuguese;
- Systematic reviews, qualitative studies, and clinical guidelines.
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Exclusion Criteria:
- Studies related exclusively to pediatrics or animals;
- Publications outside the dened time frame;
- Duplicate or non-peer-reviewed articles;
- Case reports with isolated samples.
THEORETICAL FOUNDATION
The management of patients with catastrophic abdomen is one of the greatest challenges
of emergency surgery. This condition is characterized by a state of generalized abdominal failure,
resulting from processes such as severe trauma, diuse peritonitis, necrotizing pancreatitis, or
mesenteric ischemia. The physiological impact is wide-ranging, leading to hemodynamic instability,
multiorgan dysfunction, and imminent risk of death. The surgical approach, in this context, requires
quick decisions and carefully planned strategies, centered on the concept of damage control (Sartelli
et al., 2020).
Damage control surgery is a mainstay in the treatment of catastrophic abdomen. This method
consists of a brief initial intervention to control bleeding and contamination, followed by intensive
resuscitation in the intensive care unit (ICU) and denitive surgical procedures in subsequent stages.
Studies show that this approach reduces mortality by up to 40%, especially in patients with a high
degree of hemodynamic instability (Rotondo et al., 2019). Additionally, the technique of temporary
closure of the abdomen with vacuum therapy has been widely used, promoting better control of intra-
abdominal pressure and facilitating access for future interventions (De Waele et al., 2021).
Another signicant advance in the management of catastrophic abdomen is the use of
biomarkers to monitor the inammatory response and predict complications. Biomarkers such as
procalcitonin and serum lactate help in the evaluation of the systemic response to treatment and in
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the early identication of organ failure. In addition, the development of advanced imaging tools, such
as high-resolution computed tomography, enables a more accurate diagnosis and the denition of
personalized therapeutic strategies (Reitz et al., 2020).
Technological innovation has also played a central role in the evolution of the management
of these patients. Extracorporeal support devices, such as extracorporeal membrane oxygenation
(ECMO), have been used in cases of respiratory failure associated with the catastrophic abdomen.
These devices oer vital support while primary treatment is carried out, extending survival in
critically ill patients (Bolliger et al., 2021).
On the other hand, the success in treating this condition is not limited to surgical interventions
alone. Multidisciplinary management, involving surgeons, intensivists, nurses, and nutritionists,
is crucial to optimize results. Protocols that prioritize early resuscitation, infection control, and
nutritional support have been shown to have a positive impact on clinical outcomes. Early enteral
nutrition, for example, has been associated with a lower incidence of infectious complications and
faster recovery (Kirkpatrick et al., 2021).
In addition, continuous training of medical teams and the development of evidence-based
protocols are indispensable. Institutions that implement regular simulation training for the management
of catastrophic abdomen report greater eciency in interventions and lower mortality rates. The
focus on teaching strategies that combine theory and clinical practice strengthens the ability of teams
to deal with highly complex scenarios (Blanco et al., 2021).
In the current scenario, it is evident that the treatment of catastrophic abdomen requires
an integrative and progressive approach. The combination of technological advances, well-dened
protocols, and skilled teams has transformed the landscape of the management of this critical condition,
oering hope to patients who previously faced grim prognoses (Reitz et al., 2020).
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CONCLUSION
It is concluded that the management of patients with catastrophic abdomen is one of the
greatest challenges of emergency surgery, requiring a multidisciplinary approach and progressive
strategies that combine technological advances, evidence-based protocols, and continuous training of
health teams. The implementation of techniques such as damage control surgery, the use of vacuum
therapies for abdominal closure, and cardiopulmonary support have contributed signicantly to the
reduction of mortality and improvement in clinical outcomes.
In addition, the central role of multidisciplinary management, with a focus on hemodynamic
stabilization, infectious control, and early nutritional support, demonstrates the importance of
integrated care to optimize outcomes. The development of biomarkers and advanced imaging tools
has allowed for more accurate diagnoses and targeted therapeutic interventions, expanding the
possibilities of recovery in critically ill patients.
However, treating such complex conditions requires more than technical advances. It is
essential to invest in the continuing education of professionals, development of specic protocols,
and expansion of access to specialized resources. Institutions that prioritize these aspects are able to
reduce variability in clinical practices and consistently improve outcomes.
In summary, the evolution in the surgical approach and the focus on integrated care reect
a signicant advance in the management of the catastrophic abdomen. Despite the challenges,
technological advances and the training of health teams oer a promising horizon for patients facing
this critical condition, showing that innovation combined with collaborative practice can transform
care in highly complex scenarios.
REFERENCES
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