Salud Medicina e Innovación Journal
Anastomosis primaria posterior a resección intestinal en sepsis abdominal: reporte de caso y revisión de la literatura
By Esther Salomé Loyola Cevallos, Jaime Lenin Veintimilla Hurtado, Heriberto Ortiz Martín and 2 others.
Abstract
Introduction
The decision between primary anastomosis and Hartmann's procedure in patients with abdominal sepsis and intestinal necrosis remains a subject of debate. Contemporary evidence suggests that, in carefully selected patients, primary anastomosis offers advantages in terms of quality of life without compromising surgical safety.
Objective
To describe the short-term evolution of a young patient without significant comorbidities who underwent intestinal resection and primary anastomosis in the context of abdominal sepsis.
Methods
Case report.
Results
A 23-year-old female patient, without significant clinical or surgical history, who after an appendectomy returned to the emergency department with abdominal pain, fever, and clinical findings of pelvic inflammatory disease. Free fluid in the abdominal cavity and marked leukocytosis with neutrophilia were identified. It was classified as abdominal sepsis and, given the refusal of reception at a higher-complexity hospital and the appearance of signs of hemodynamic instability, emergency surgical intervention was decided. Intraoperatively, necrosis of a significant segment of the ileum, purulent fluid in the abdominal cavity, metabolic acidosis, and early-stage septic shock were identified. Intestinal resection and primary side-to-side anastomosis in two layers were performed, without a protective stoma. Postoperative evolution was favorable during hospitalization and at two- and three-month follow-up.