Non-access
adhesiolysis, intestinal injury, abscess, low-output fistula, intestinal injuries
TUMOR PROGRESSION, ABSCESS, ADHESIONS
We identified 21 patients with a non-access abdomen, 15 during their first PIPAC attempt, and six during one of the subsequent ones. Five abdominal cavities were inaccessible, and 16 were inadequately accessible, as severe intraabdominal adhesions prevented establishing of a sufficient capnoperitoneum and would have obstructed the aerosol’s distribution. In eight of these twenty-one patients, inserting the trocar and adhesiolysis resulted in consecutive intestinal injuries, six of the small intestine, and two of the large intestine (each in equal parts serosa lesions and transmural perforations). The operation had to be converted to a laparotomy in five patients for an intestinal suture of these perforations.The postoperative course of all non-access patients was mostly uneventful. Seventeen patients scored Grade 0 or I according to the CDC. The remaining four patients scored Grade II and are described briefly: One patient was given antibiotics (cefuroxime and metronidazole) after a non-access followed by an abscess in the abdominal wall. Three patients had to receive parenteral nutrition due to intestinal injury. One of them was also given somatotropin-inhibitory hormone (8 days) and octreotide (4 days) to control intestinal secretion and showed signs of a low-output fistula that had a stable flow rate of about 100 mL/d. Of the four patients, three were discharged in improved general condition. One patient developed a significant tumor progression during the hospital stay and was transferred to a hospice.We attempted one second PIPAC procedure after a patient had presented with a non-access abdomen, which failed, because the abdomen remained inaccessible.