INTRODUCTION• It is the disruption of an abdominal wound,occurring usually between the 6th and 8th daysafter an operation.• Usually sutures opposing the deep layers, i.e..Peritoneum and rectus sheath tear throughcausing burst abdomen.
CLINICAL FEATURES• A sudden feeling of giving away from the wound – onthe 6th to 8th postoperative day often precipitated bybouts of severe cough.• Pinkish serosanguinous discharge from the wound.• Often omentum or coils of intestine are forced out ofthe wound.• Pain and shock is often present.• Clinically burst abdomen can be diagnosed without fail.
FACTORS RELATED TO BURST ABDOMEN• Choice of suture materials used.• Method of closure : Continuous sutures more likely todisrupt than interrupted sutures.• Midline and vertical wounds are more likely to disrupt thantransverse.• Surgical wounds of peritonitis, acute abdomen, majorsurgeries like pancreatic, hepatic, gastric, surgeries formalignancies have a high incidence of disruption.• Severe cough, vomiting and distension in early post-operative period.• Poor general condition of patient – Anemia, jaundice,hypoproteinemia, obesity, uremia and diabetes mellitus.
TREATMENT• Nasogastric aspiration• IV fluids• Emergency surgery
SURGERY• Each protruding coil of intestine is gently washed withsaline solution and returned to the abdominal cavity.• Protruding greater omentum treated similarly and spreadover the intestine.• Having cleansed the abdominal wall all layers areapproximated by through and through sutures ofmonofilament nylon, which may be passed throughthrough a soft rubber or plastic tube collar.• The abdominal wall may be supported by strips ofadhesive plaster encircling the anterior two thirds of thecircumference of the trunk.• Antibiotic therapy is started.• Wound usually heals well without second dehiscence.Late problem, maybe development of incisional hernia.
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