Management of abdominal wall clostridial myonecrosis: the role of total gastrointestinal diversion.

We report the successful management of two patients with abdominal wall gas gangrene and emphasize the principles of proximal gastrointestinal diversion and the initial use of 100% fraction of inspired oxygen (FiO2). Each patient lacked an abdominal wall and intractable fistulas developed. Complete diversion of their gastrointestinal tracts at a proximal level facilitated closure of the fistulas and prevented possible peritoneal contamination. One patient's arterial oxygen pressure was maintained in the 200 to 300 range for two days after admission. This level has been shown to be adequate to stop clostridial alpha toxin production.