Catastrophic abdomen after appendicular peritonitis, multidisciplinary experience: A case report

Abstract

The term 'catastrophic abdomen' describes a series of complex and severe medical situations that combine significant inflammation, severe infections and a history of multiple abdominal surgeries that alter the normal anatomy. In these conditions, the internal organs become especially vulnerable, presenting fragility and an edematous state, i.e. swelling due to fluid accumulation. In addition, in certain cases, there may be the presence of fistulas or intestinal leaks that are difficult to control, further complicating the patient's clinical situation. When this situation is combined with the presence of extensive adhesions or significant scarring, it is referred to by the term 'hostile abdomen'. Finally, in the case of intestinal fistulas connecting directly with the granulation tissue overlying the viscera, a phenomenon known as enteroatmospheric fistulation is generated. 13-year-old male patient diagnosed with catastrophic abdomen. He underwent laparotomy due to generalized peritonitis and intestinal perforation. During the procedure, the Bogota bag, the Bates system and a fistula were used, and abdominal wall closure through “component separation” with fasciotomy of the rectus abdominis, in addition to parenteral nutritional support. The incidence of 'catastrophic abdomen' is extremely low, with an estimated prevalence of approximately one case per-100,000 population, according to the World Health Organization (WHO). By presenting our case, we aimed to highlight the multidisciplinary approach and surgical management strategies in addressing catastrophic abdomen resulting from appendicular peritonitis, emphasizing complex interventions and patient outcomes.