Overview
A carbuncle of the abdominal wall represents a severe, often infected, localized collection of abscesses causing significant morbidity. It typically arises from deep tissue infection and can necessitate complex surgical interventions, especially in cases of extensive contamination or abdominal compartment syndrome. 13Diagnosis
Clinical presentation includes localized redness, swelling, pain, and systemic signs of infection.
Imaging (e.g., ultrasound, CT) may be used to assess extent and complications.
Cultures from aspirated pus are crucial for identifying pathogens and guiding antibiotic therapy. 13Management
First-line treatment: Broad-spectrum antibiotics tailored based on culture results.
Surgical intervention:
- Decompressive laparostomy for abdominal compartment syndrome 1.
- One-stage repair using Components Separation Method for large contaminated defects 3.
Wound management:
- Non-infected fields: Wittmann patch or Negative Pressure Wound Therapy (NPWT) preferred 1.
- Infected fields: NPWT techniques recommended 1.
Postoperative care: Close monitoring for complications such as wound infections, fistulas, and sepsis. 3Special Populations
Pregnancy: Antenatal diagnosis of abdominal wall defects like omphalocele and gastroschisis is crucial; mode and timing of delivery remain controversial 4.
Pediatrics: Exomphalos (especially major defects) carries higher mortality and prolonged hospital stays 2.
Comorbidities: Patients with critical conditions or those failing less invasive treatments may require preventive "open abdomen" strategies 1.Key Recommendations
Consider decompressive laparostomy in patients with abdominal compartment syndrome or those not responding to medical management (Evidence: Moderate) 1.
For large, contaminated abdominal wall defects, a one-stage repair using the Components Separation Method can be effective (Evidence: Weak) 3.
In non-infected fields, Wittmann patch or Negative Pressure Wound Therapy (NPWT) should be prioritized for wound closure (Evidence: Moderate) 1.
Tailor antibiotic therapy based on culture results from abscess aspirates (Evidence: Expert opinion) 3.
Closely monitor for postoperative complications including wound infections and sepsis in complex abdominal wall repairs (Evidence: Expert opinion) 3.References
1 Piccoli M, Agresta F, Attinà GM, Amabile D, Marchi D. "Complex abdominal wall" management: evidence-based guidelines of the Italian Consensus Conference. Updates in surgery 2019. link
2 Vachharajani AJ, Rao R, Keswani S, Mathur AM. Outcomes of exomphalos: an institutional experience. Pediatric surgery international 2009. link
3 van Geffen HJ, Simmermacher RK, van Vroonhoven TJ, van der Werken C. Surgical treatment of large contaminated abdominal wall defects. Journal of the American College of Surgeons 2005. link
4 Catizone FA. Prenatal diagnosis of abdominal wall defects. Fetal therapy 1986. link
5 Elsahy NI. Abdominoplasty combined with correction of the flaccidity of the lateral lower abdomen and the flanks. Aesthetic plastic surgery 1985. link
6 Evans JA, Darvill KD, Trevenen C, Rockman-Greenberg C. Cloacal exstrophy and related abdominal wall defects in Manitoba: incidence and demographic factors. Clinical genetics 1985. link
7 Pagon RA, Smith DW, Shepard TH. Urethral obstruction malformation complex: a cause of abdominal muscle deficiency and the "prune belly". The Journal of pediatrics 1979. link80210-3)