Temporary Bowel Ligation and Negative Pressure Therapy in Damage Control Surgery for the Management of Septic Shock Secondary to Non-traumatic Intestinal Perforation

Abdominal sepsis from non-traumatic intestinal perforations in patients with multiple comorbidities presents a significant surgical challenge. The need for rapid intervention to manage contamination and restore intestinal continuity is often complicated by hemodynamic instability. A 64-year-old female with a history of cervical cancer and right colon adenocarcinoma in remission presented with severe abdominal pain, nausea, vomiting, and signs of septic shock. Imaging revealed dilated intestinal loops, thickened walls, free fluid, and signs of mesenteric congestion. An exploratory laparotomy revealed intestinal ischemia, extensive intra-abdominal contamination, and perforations. Temporary bowel ligation was performed, and negative pressure wound therapy (NPWT) using the ABThera™ system was applied to manage the open abdomen. After hemodynamic stabilization and improvement in laboratory values, a second-look procedure was performed, during which a delayed anastomosis was successfully completed. This case highlights the effective use of damage control surgery (DCS), temporary bowel ligation, and NPWT in complex abdominal sepsis management. Negative pressure wound therapy (NPT) facilitated contamination control, reduced intestinal edema, and prepared the patient for safe anastomosis in a later surgery. Although controversial, the decision to delay the anastomosis was advantageous in this case, as it minimized the need for a permanent stoma and allowed for the restoration of intestinal continuity. This report contributes to the growing body of evidence supporting the combination of temporary bowel ligation and NPT in the management of severe abdominal sepsis. It emphasizes the need for individualized treatment strategies, and further studies are required to establish clear patient selection criteria.