The impossible abdomen in a complex patient: treatment with novosorb biodegradable temporizing matrix (BTM) for frozen abdomen with entero-atmospheric fistula.

Abstract

Managing patients with severe fixation of intra-abdominal contents, known as frozen abdomen, often creates a vicious cycle of tissue injury that further prolongs open abdomen resolution. We share the management course of a 28-year-old male status post motor vehicle accident with traumatic pancreatitis and complex liver injury. Following multiple laparotomies for abdominal wash out, he developed a frozen abdomen and an entero-atmospheric fistula (EAF) through granulated bowel. The exposed granulated bowel, bilious leak and fistula limited options for abdominal closure and ostomy appliance placement. NovoSorb Biodegradable Temporizing Matrix (BTM) applied to the granulated bowel eventually allowed an ostomy appliance to be placed around the fistula on top of the non-absorbable layer of the BTM. Eventual fistula closure was achieved and appropriate granulation tissue had formed prior to autografting. This is the first report utilizing BTM to aid in the closure of open abdomen in the setting of frozen abdomen with EAF.