Intrauterine negative-pressure therapy (IU-NPT) to treat peritonitis after caesarean section.

Autor:	Wulfert CH; Department of General Surgery, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany., Müller CT; Department for General, Abdominal, Thoracic and Vascular Surgery, Kath. Marienkrankenhaus Hamburg, Hamburg, Germany., Abdel-Kawi AF; Department of Obstetrics, Kath. Marienkrankenhaus Hamburg, Hamburg, Germany., Schulze W; Department for General, Abdominal, Thoracic and Vascular Surgery, Kath. Marienkrankenhaus Hamburg, Hamburg, Germany., Schmidt-Seithe H; Department for General, Abdominal, Thoracic and Vascular Surgery, Kath. Marienkrankenhaus Hamburg, Hamburg, Germany., Borstelmann S; Department of Obstetrics, Kath. Marienkrankenhaus Hamburg, Hamburg, Germany., Loske G; Department for General, Abdominal, Thoracic and Vascular Surgery, Kath. Marienkrankenhaus Hamburg, Hamburg, Germany.
Jazyk:	angličtina
Zdroj:	Innovative surgical sciences [Innov Surg Sci] 2020 Oct 01; Vol. 5 (1-2), pp. 67-73. Date of Electronic Publication: 2020 Oct 01 (Print Publication: 2020).
DOI:	10.1515/iss-2020-0014
Abstrakt:	Objectives: We describe the first application of intrauterine negative-pressure therapy (IU-NPT) for an early rupture of a uterine suture after a third caesarean section with consecutive peritonitis and sepsis. Because all four quadrants were affected by peritonitis, a laparotomy was performed on the 15th day after caesarean section. Abdominal negative-pressure wound therapy (A-NPWT) of the open abdomen was initiated. During the planned relaparotomy, a suture defect of the anterior uterine wall was identified and sutured. In the second relaparotomy, the suture appeared once more insufficient. Case Presentation: For subsequent IU-NPT, we used an open-pore film drainage (OFD) consisting of a drainage tube wrapped in the double-layered film. The OFD was inserted into the uterine cavity via the uterine defect and IU-NPT was established together with A-NPT. With the next relaparotomy, local inflammation and peritonitis had been resolved completely. IU-NPT was continued transvaginally, the uterine defect was sutured, and the abdomen was closed. Vaginal IU-NPT was also discontinued after another eight days. Conclusions: By using IU-NPT, local infection control of the septic focus was achieved. The infectious uterine secretions were completely evacuated and no longer discharged into the abdominal cavity. As a result of the applied suction, the uterine cavity collapsed around the inlaid OFD. The total duration of IU-NPT was 11 days. The uterine defect was completely closed, and a hysterectomy was avoided. The patient was discharged four days after the end of IU-NPT. IU-NPT follows the same principles as those described for endoscopic negative-pressure wound therapy of the gastrointestinal tract. Competing Interests: Competing interests: Gunnar Loske is a consultant of Lohmann & Rauscher GmbH & Co. KG. (© 2020 Chris-Henrik Wulfert et al., published by De Gruyter, Berlin/Boston.)
Databáze:	MEDLINE
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