Damage control surgery by keeping the abdomen open during pregnancy: favorable outcome, a case report

30-year-old woman at 23 week of pregnancy was investigated for non-specific abdominal pain. Surgical exploration revealed extensive ischemic bowel necrosis. Multiple segmental resections were performed and abdomen was left open with vacuum assisted dressing, maintained for 48 hours. At the third surgical look the continuity was restored and abdominal wall closed. The foetal condition stayed unperturbed under pharmacologic tocolysis. Pregnancy was carried to full term delivery.Open abdomen strategy can be successfully applied in pregnant woman.Acute abdominal pain in advanced pregnancy remains a diagnostic and management challenge. During pregnancy the usual clinical presentation is masked by gravid uterus and physiological changes. Imaging procedures can rarely help to resolve a diagnostic dilemma because of modified abdominal anatomy and limits in x-ray techniques use [1]. For these reasons the rate of accurate preoperative diagnosis is still considerably lower than in non-pregnant patients. In many cases early laparoscopy is the best both diagnostic and therapeutic tool [2].For the most frequent acute abdomen causes including acute appendicitis, cholecystitis, mechanical obstruction and gastric ulcer perforation standard surgical management gives relatively good outcomes with overall 6% of miscarriage, 2.5% of foetus lost and less then 4% of premature labour rate [3]. The maternal mortality rate is comparable to non-pregnant surgical patients. Long-term follow-up of laparoscopic surgery proves the safety and efficiency of this technique in pregnant woman [4].However, the decision to operate is often delayed during pregnancy. This is probably the first reason of high foetal or mother morbidity. The recommendation in these situations is to manage the surgical problem regardless of the pregnancy using the same surgical strategy as for non-pregnant patient [5].A 30-year-old woman was admitted to the emergency department at 23 week of her second pregnancy for non-speci