By Sanjay George

BURST ABDOMEN

INTRODUCTION• It is the disruption of an abdominal wound,

occurring usually between the 6th and 8th days after an operation.

• Usually sutures opposing the deep layers, i.e.. Peritoneum and rectus sheath tear through causing burst abdomen.

CLINICAL FEATURES• A sudden feeling of giving away from the wound – on

the 6th to 8th postoperative day often precipitated by bouts of severe cough.

• Pinkish serosanguinous discharge from the wound.

• Often omentum or coils of intestine are forced out of the 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 to disrupt than interrupted sutures.

• Midline and vertical wounds are more likely to disrupt than transverse.

• Surgical wounds of peritonitis, acute abdomen, major surgeries like pancreatic, hepatic, gastric, surgeries for malignancies 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 with saline

solution and returned to the abdominal cavity.• Protruding greater omentum treated similarly and spread over

the intestine.• Having cleansed the abdominal wall all layers are

approximated by through and through sutures of monofilament nylon, which may be passed through through a soft rubber or plastic tube collar.

• The abdominal wall may be supported by strips of adhesive plaster encircling the anterior two thirds of the circumference 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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