Dear all interested in the Bogota bag thread,
I had an anecdotal experience somewhat similar to that of Iain. A
debilitated patient who had complicated parastomal hernia with a massively
prolapsing tranverse colon with gangrene and peritonitis. I ended up with
placing a plastic bag for closure. Every 2-3 days I took the patient back to
the OR, examined for for abscess pockets and evacuated as necessary,
performed generous irrigation, and attempted to tighten the plastic sheet.
After about 5 such procedures, the bowels were all encased in a fibrinous
layer with no residual abscesses, and the fascial edges got somewhat closer.
At that point I removed the bag and used bedside wet-to-wet dressing changes
and left the area to granulate. The most important thing is that the
dressing had to be absolutely non-adherent (used vaselinized gauze and
sometimes Adaptec), otherwise a fistula is a given. The patient did well,
coverage was achieved with split-thickness skin graft, and the patient was
left with a good hernia. I lost his follow-up, (because I completed my