Official websites use. Share sensitive information only on official, secure websites. Address for correspondence Jean H. Caring for a patient with a hostile abdomen is one of the most challenging clinical situations one can encounter. It requires specialized technical skill coupled with bold but thoughtful decision-making to achieve good outcomes.
An approach to the patient with a complex, hostile abdomen must be individualized to account for the patient's personal details. However, implementing an experienced-based algorithm to help make the difficult decisions required in this setting can be helpful, as evidence-based studies are few.
The purpose of this review is to provide a structured, evidence, and experienced-based approach to the challenges that the surgeon encounters when faced with a patient with a hostile abdomen, and to discuss perioperative and intraoperative surgical strategies that can lead to most successful outcomes.
Keywords: hostile abdomen, revisional abdominal surgery, enteric fistula, dense adhesions. From time to time, the surgeon will be asked to care for a patient with a significant loss of normal abdominal anatomy, characterized by a friable, delicate intestine that is often scarred and congealed into one solid mass, and sometimes complicated with enteric fistulae.
Some of these factors are, but not limited to, inflammatory processes that result in sepsis such as perforating Crohn's disease, chronic fibrosis from external beam radiation therapy, sequela of anastomotic leak, traumatic injury, or adhesive disease after prior operation. There are several reasons why the surgeon would be faced with the need to explore a hostile abdomen. The individual could be plagued with a complication associated with a hostile abdomen like a chronic bowel obstruction, anastomotic leak, or an entero-atmospheric fistula that requires repair.
