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Comparative efficacy of sequential treatment and open abdomen approaches for corrosive abdominal hemorrhage due to inadequate drainage of duodenal leakage: a cohort study

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A Correction to this article was published on 04 December 2023

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Abstract

Background

Intra-abdominal bleeding resulting from inadequate drainage of duodenal leakage (DL) is typically caused by the corrosiveness of duodenal fluid. Open abdomen (OA) treatment addresses both the drainage and bleeding simultaneously. However, a sequential treatment (ST) approach involving hemostasis through transcatheter arterial embolization (TAE) followed by percutaneous drainage of source control has emerged as an alternative method. This study aimed to evaluate the prognosis of ST in cases of DL-induced intra-abdominal bleeding.

Methods

This retrospective cohort study included 151 participants diagnosed with DL-induced intra-abdominal bleeding from January 2004 to December 2010, and January 2013 to December 2021. The ST and OA groups were established based on the treatment method applied. Propensity score-matching (PSM) matched patients in the ST group with those in the OA group.

Results

Among the 151 patients, 61 (40.4%) died within 90 days after the bleeding episode. ST was associated with a lower mortality rate (28.2% vs. 51.3% adjusted odds ratio [OR] = 0.34; 95% confidence interval [CI] 0.17–0.68; P = 0.003) compared to OA. Following PSM, ST remained the only factor associated with reduced mortality (OR = 0.32; 95% CI 0.13–0.75; P = 0.009). Moreover, ST demonstrated a higher rate of initial hemostasis success before (90.1% [64/71] vs. 77.5% [62/80]; adjusted OR = 2.84; 95% CI 1.07–7.60; P = 0.04) and after PSM (94.4% [51/54] vs. 77.8% [42/54], adjusted OR = 3.85; 95% CI 2.15–16.82; P = 0.04). Additionally, ST was associated with a lower incidence of rebleeding within 90 days after the initial bleeding, before (7 vs. 23; adjusted OR 0.41; 95% CI 0.18–0.92; P = 0.03) and after PSM (5 vs. 14; adjusted OR 0.37; 95% CI 0.15–0.93; P = 0.03).

Conclusions

Applying ST involving TAE and subsequent percutaneous drainage might be superior to OA in lowering the mortality in DL-induced intra-abdominal hemorrhage.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Change history

Abbreviations

ACS:

Abdominal compartment syndrome

AHF:

Acute hepatic failure

AKF:

Acute kidney failure

ARF:

Acute respiratory failure

BMI:

Body mass index

DL:

Duodenal leakage

CI:

Confidence interval

CT:

Computed tomography

DSA:

Digital subtraction angiography

DL:

Duodenal leakage

MOSD:

Multiple organ dysfunction syndrome

OA:

Open abdomen

OR:

Odds ratio

PSM:

Propensity score-matching

SOFA:

Sequential Organ Failure Assessment

ST:

Sequential treatment

TAE:

Transcatheter arterial embolization

TAC:

Temporary abdominal closure

VAWCM:

Vacuum-assisted wound closure and mesh

WSACS:

World Society of the Abdominal Compartment Syndrome

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Acknowledgements

We would thank Bullet Edits Limited for the linguistic editing and proofreading for the manuscript.

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Authors and Affiliations

  1. Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu, China

    Zheng Yao, Guoping Zhao, Shikun Luo, Xin Xu & Risheng Zhao

  2. Department of General Surgery, Jinling Hospital, Nanjing, Jiangsu, China

    Weiliang Tian & Qian Huang

  3. Department of General Surgery, Suzhou Ninth Hospital Affiliated to Soochow University, Suzhou, Jiangsu, China

    Ke Chen

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  1. Zheng Yao
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Contributions

QH and RZ provide research objects. KC reviewed charts and filter out objects. ZY, XX and RZ collected and analysed the data; ZY, XX and RZ wrote the main manuscript text; ZY prepared figures. ZY designed the research. GZ and SL revised the manuscript. SL, GZ and ZY were the first authors. ZY, RZ and KC were the corresponding authors.

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Correspondence to Ke Chen or Risheng Zhao.

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Zheng Yao, Guoping Zhao, Shikun Luo, Risheng Zhao, Weiliang Tian, Xin Xu, Qian Huang, and Ke Chen have no conflicts of interest or financial ties to disclose.

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464_2023_10525_MOESM1_ESM.jpg

Double-lumen irrigation–suction tube consists of irrigation catheter (✩), suction catheter (identified by black arrow), and end-closed supporting pipe which was riddled with holes with diameter of about 3 mm (the distance between each hole is about 1 cm, identified by white arrow. Supplementary file1 (JPG 822 kb)

The patients and grouping.Supplementary file2 (JPG 139 kb)

Risk factors associated with rebleeding before PSM. Supplementary file3 (JPG 323 kb)

Risk factors associated with rebleeding after PSM. Supplementary file4 (JPG 297 kb)

Supplementary file5 (DOC 166 kb)

Supplementary file6 (DOC 23 kb)

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Yao, Z., Zhao, G., Luo, S. et al. Comparative efficacy of sequential treatment and open abdomen approaches for corrosive abdominal hemorrhage due to inadequate drainage of duodenal leakage: a cohort study. Surg Endosc 38, 85–96 (2024). https://doi.org/10.1007/s00464-023-10525-9

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