Seminar on burst abdomen.

1. By Sanjay George
BURST ABDOMEN

2. 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.

5. 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.

6. 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.

7. TREATMENT
• Nasogastric aspiration
• IV fluids
• Emergency surgery

8. 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.