A Review for Hostile and Frozen Abdomen

Abstract

Frozen abdomen is a condition characterized by the loss of natural free spaces between intra-abdominal organs and compartmental structures, leading to pathological changes out of normal anatomical proportion. This condition is often caused by surgical procedures, such as peritonitis, severe acute pancreatitis, anastomotic leakage, ostomies, phased care of abdominal injuries, decompressive laparostomy, Crohn's disease, peritoneal carcinomatosis, or radiation. Aggressive abdomens are often a nightmare for surgical procedures, presenting with symptoms such as abdominal discomfort, infection, anastomotic leakage, and impaired intestinal transit. Diagnosis of a hostile abdomen is often made during the operation itself, with surgeons' decision-making heavily influenced by the situation being examined. Post-diagnosis, it is crucial to delay any surgical intervention as much as possible, as the disease's nature makes operative management difficult and puts the patient at a high risk of inadvertent injuries, intestinal resections, trans-operative bleeding, and other complications. The ideal surgical management for a hostile abdomen is "no management." Surgeons are the leading cause of short bowel syndrome worldwide, characterized by needless intestine resections due to accidental damage or insufficient dissection during abdominal surgery in the context of an aggressive abdomen. In these cases, intestinal anastomosis is not indicated due to the patient's insufficient local circumstances for the repair of the intestinal wall and systemic factors that do not conducive to optimal tissue healing.