The document discusses abdominal dehiscence, or burst abdomen, which occurs when a laparotomy wound ruptures after surgery. It defines abdominal dehiscence and lists factors related to it, including patient factors like malnutrition or obesity, and surgical factors like suture material and wound closure technique. The document outlines clinical features of a burst abdomen and management approaches, which involve resuturing the abdominal wall in surgery followed by postoperative care measures.

1. OPERATIVE SURGERY NOTES
ABDOMINAL DEHISCENCE
DALITSO MASEKO (Mr.)
BARCHELOR OF CLINICAL SCIENCE STUDENT (2014-2016)
CAVENDISH UNIVERSITYZAMBIA
31-Jan-16

2. INTRODUCTION
Definition:
BurstAbdomen or Abdominal Dehiscence is disruption of a laparotomy wound
occurring usually 5th and 8th postoperative day.
Usually occurs at sutures opposing the deep layers, i.e. peritoneum and rectus
sheath tear through, causing burst abdomen.
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3. FACTORS RELATEDTO BURST ABDOMEN
Abdomen is likely to burst if:
PATIENT FACTORS
1. Poor general condition of the patient- extremes of age (old and very young),
malnutrition, immunopathology, anaemia, jaundice, hypoproteinaemia, obesity.
2. Severe cough, vomiting and distension in post-operative period.
3. Abdomen is swollen for any reason, such as ileus, intestinal obstruction, or a large
tumour.
4. Has severe abdominal sepsis, such as an infected caesarean section, typhoid
peritonitis, or a perforation of large gut.
5. Has carcinomatosis, uraemia, or obstructive jaundice.
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4. FACTORS RELATEDTO BURST ABDOMEN
SURGICAL FACTORS
1. Choice of suture materials used. Absorbable material poor choice.
2. Method of closure: continuous closure is more likely to disrupt than interrupted
sutures. Layers taking bites of tissues that are too small. (shouldn’t be too tight
and take wide bites of tissue)
3. Upper midline and vertical wounds are more likely to disruption.
4. Surgical wounds of peritonitis, acute abdomen, and major surgeries like
pancreatic, hepatic, gastric, surgeries for malignancies have high incidence of
disruption.
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5. CLINICAL FEATURES
 A sudden feeling of giving way from the wound on 5th to 8th post op day often
precipitated by bouts of severe cough.
 Pinkish serosanguinous discharge from the wound.
 Often omentum or coils of intestines are forced out of the wound.
 Clinically burst abdomen can be diagnosed without fail.Treat before it bursts.
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6. CLINICAL FEATURES SHOWING BURST ABDOMEN
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7. MANAGEMENT
1. Nasogastric aspiration
2. IV fluids
3. Pain management
4. Emergency surgery
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8. SURGICAL MANAGEMENT
Prepare for theatre/laparotomy.
If the abdomen has burst give general anaesthesia. Only repair under local
anaesthesia if very unfit for GA.
Remove the skin sutures in the area where you suspect the burst.
Remove the dressings and gently explore the depths of the wound with a
sterile gloved finger. Open it down its whole length by removing all the skin
sutures.You will soon find out what has happened.
If you confirm a burst abdomen, remove all sutures from the fascial layers.
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9. SURGICAL MANAGEMENT
Try to insert your finger between the parietal peritoneum and underlying gut and
omentum. In this way you should be able to mobilize enough of the abdominal
wall to take some more sutures.
Re-suture the abdominal wall with interrupted steel or monofilament sutures,
either intermittent or continuous. Suture from within outwards through the
peritoneum, posterior rectus sheath, rectus muscle, and anterior rectus sheath
(but not through the skin).
Hold all the sutures out on haemostats until you have placed the last one.
Some surgeons also insert tension sutures (consider that this is the only
indication for them).
If indicated insert a peritoneal drain for 14 days.
If his skin is already infected, use delayed closure, and graft it later if necessary
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10. POST OPERATIVE CARE
 Wound cleaning
 IV fluids
 Antibiotics
 Nursing care
 Nutritional care
 Psychological care
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11. CONCLUSION
Wound dehiscence is a surgical complication, that caries a 30%
mortality, in which a wound ruptures along a surgical incision.
Most of the risk factors are either preventable or modifiable. It is
imperative to manage it before it clinically occurs.
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12. REFERENCES
1. Rusiani L. and Robbins P. (2008).Textbook of dermatologic surgery. PICCIN.
2. Sriram Bhat M. (2005). SRB’S Manual of Surgery, 2nd edition. Jaypee Brothers
Medical Publishers (P) Ltd. India
3. Wound Dehiscence (Surgical Wound Dehiscence; Operative Wound
Dehiscence). EBSCO Industries. 2010-09-01. Retrieved 2011-06-24
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