Introduction

Management of abdominal sepsis may require delayed primary closure for further resuscitation and ongoing source control. Little is known regarding the outcomes in the pediatric population therefore, we evaluated children with abdominal sepsis to determine indications and outcomes from open abdomen.

Methods

A retrospective chart review was performed on pediatric patients (≤18 years) with delayed abdominal closure for abdominal sepsis (ICD 9 code 567.9) at a single institution (2015-2022). Of the initial 20 patients, 3 were excluded due to death within 24 hours of surgery. Patient demographic, clinical variables (rationale for surgery, indication for open abdomen, approach for temporary abdominal closure, need for mesh at definitive closure), and outcomes (ICU days, hospital stay, ventilator days, time to feed and antibiotic days) were collected. We defined those who required 3 or more surgeries as prolonged open abdomen (POA). Comparative statistics were performed using Mann-Whitney U test.

Results

Of the 17 patients that met inclusion criteria (median age 18 days, IQR 8), 47% were female, 76% were white, with a survival rate of 94% (16/17). Sepsis was secondary to small bowel obstruction (4/17, 24%), perforation from necrotizing enterocolitis (NEC) (4/17, 24%), non-NEC perforation (4/17, 24%), and other causes (5/17, 29%). Indications for an open abdomen were planned second look (11/17, 65%), intraoperative instability (4/17, 24%), and inability to tolerate closure (2/17, 12%). Wound vac was the most common temporary abdominal closure method 10/17 (59%), followed by a silo 4/17 (23%). Patients underwent a median of 3 surgeries (IQR 3.5) with 88% (15/17) achieving primary closure (2 required mesh). POA (n=9) had a similar ICU stay, hospital stay, time on ventilator, and time to initial feeds (Table 1). However, antibiotic duration was greater in POA’s (33 days IQR 56 vs 50 IQR 68, p=0.29), as 67% developed secondary infection during their ICU stay.

Conclusion

A high survival rate was shown in the largest series of pediatric patients requiring open abdomen for abdominal sepsis. Nearly all achieved primary closure despite multiple surgeries. Those with prolonged open abdomens had more secondary infections and increased antibiotic days, however, this had minimal impact on overall outcomes.

Median (IQR) or # (%); central line associated bloodstream infection (CLABSI); urinary tract infection (UTI); ventilator associated pneumonia (VAP); prolonged open abdomen was defined as 3 surgeries.