Historical Perspective

Abstract

Few advances have had a major impact on acute care and trauma surgery as much as current management of the open abdomen. Sometimes called “laparostomy,” the concept of leaving an abdomen open after surgery is not new. E.C. Wendt noted the reduced urinary flow in the presence of abdominal hypertension as early as 1876. When surgeons of yesteryear operated on peritoneal patients, they often were concerned about the “enormous pressure increase that often precluded abdominal closure.” Marey in 1863 and Henricus in 1890 commented on the adverse effects of increased intra-abdominal pressure. In 1911, Emerson introduced his readers to a series of elegant experiments with the statement that “pressure conditions which exist within the peritoneal cavity had received insufficient attention.” Baggot, an Irish anesthetist, suggested that forcing distended bowel back into the abdominal cavity of limited size might kill the patient from abdominal wound dehiscence (“abdominal blowout”) and coined the term acute tension pneumoperitoneum in 1951. Despite all these condemnations of closing an abdomen under tension, the practice continued well into the late twentieth century.