Challenges and Management of Open Abdomen in Resource-limited Settings: A Case Report of a Morbidly Obese Patient with Mesenteric Panniculitis

Abstract

Management of the open abdomen in a resource-limited settings is challenging but essential, especially in abdominal sepsis and trauma, where timely fascial closure significantly impacts outcomes. We present the case of a 52-year-old morbidly obese female diagnosed with mesenteric panniculitis due to a sealed-off ileal perforation who underwent exploratory laparotomy. Due to severe inflammation and the inability to achieve primary abdominal closure, temporary coverage was innovatively performed using a sterile urobag. Managed with restrictive fluid therapy, total parenteral nutrition, and strict infection control measures in an intensive care environment, the patient subsequently underwent staged abdominal closure with the ABTHERA vac system. Successful fascial closure was achieved by postoperative day 6, with the patient progressing effectively to enteral nutrition and being discharged without significant complications. This case underscores the importance of managing complex open abdomen scenarios even in settings with limited resources through meticulous perioperative strategies and creative solutions.