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    Burst Abdomen: by DR - Suhaib

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    suhaibrehaman
    Burst abdomen occurs when the layers of the abdominal wall rupture, either partially or completely. Risk factors include midline incisions, deep wound infections from the initial surgery, obesity, diabetes, and conditions that weaken the abdominal wall. Symptoms include a feeling of giving way in the abdominal wall along with discharge of bowel contents. Treatment involves covering the contents, draining the stomach, giving IV fluids and antibiotics, and surgically repairing the fascial layers. Primary closure is attempted when possible but mesh or biologics may be needed for weakened tissue.

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    Burst Abdomen: by DR - Suhaib

    Uploaded by

    suhaibrehaman
    641 views15 pages
    Burst abdomen occurs when the layers of the abdominal wall rupture, either partially or completely. Risk factors include midline incisions, deep wound infections from the initial surgery, obesity, diabetes, and conditions that weaken the abdominal wall. Symptoms include a feeling of giving way in the abdominal wall along with discharge of bowel contents. Treatment involves covering the contents, draining the stomach, giving IV fluids and antibiotics, and surgically repairing the fascial layers. Primary closure is attempted when possible but mesh or biologics may be needed for weakened tissue.

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    Burst Abdomen

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    Burst abdomen occurs when the layers of the abdominal wall rupture, either partially or completely. Risk factors include midline incisions, deep wound infections from the initial surgery, obesity, diabetes, and conditions that weaken the abdominal wall. Symptoms include a feeling of giving way in the abdominal wall along with discharge of bowel contents. Treatment involves covering the contents, draining the stomach, giving IV fluids and antibiotics, and surgically repairing the fascial layers. Primary closure is attempted when possible but mesh or biologics may be needed for weakened tissue.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    641 views15 pages

    Burst Abdomen: by DR - Suhaib

    Uploaded by

    suhaibrehaman
    Burst abdomen occurs when the layers of the abdominal wall rupture, either partially or completely. Risk factors include midline incisions, deep wound infections from the initial surgery, obesity, diabetes, and conditions that weaken the abdominal wall. Symptoms include a feeling of giving way in the abdominal wall along with discharge of bowel contents. Treatment involves covering the contents, draining the stomach, giving IV fluids and antibiotics, and surgically repairing the fascial layers. Primary closure is attempted when possible but mesh or biologics may be needed for weakened tissue.

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    Burst Abdomen

    By Dr.Suhaib
    Introduction
    • Disruption of an abdominal wound.
    • it may be limited to the deep fascia with the skin
    remaining intact.
    • When it is complete, all the layers of the abdominal
    wall have burst apart with or without associated
    protrusion of a viscus (evisceration).
    • The mean time to wound dehiscence is 8–10
    postoperative days
    Anatomy
    • Abdominal wall
    – Skin
    – Subcutaneous layers
    – Ext oblique with
    aponeurosis.
    – Internal oblique forming
    rectus sheath
    – Transverse abdominis
    – Transversalis fascia
    – Extraperitoneal fat
    – Peritoneum
    Factors relating to the incidence of
    burst abdomen and
    incisional hernia
    Technique of wound closure
    • Choice of suture material
    • Catgut leads to high incidence then non absorbable
    sutures
    • Method of closure
    • Interrupted sutures have low incidence
    • High incidence in single layer closure then two layer
    closure.
    • Using short material and keeping the wound taut.
    • Drainage
    • Drainage through the same wound increases the
    incidence
    Factors relating to incision
    • Midline and vertical incisions have higher
    incidence.
    Reasons for initial operation
    • Deep wound infection is notorious for causing
    burst abdomen or late incisional hernia.
    • Wounds –peritonitis, acute abdomen,
    pancreatic, hepatic ,gastric surgeries for
    malignancy have high incidence of disruption.
    Coughing,vomiting and distension
    • Any violent coughing set off by the removal of
    an endotracheal tube and suction of the
    laryngopharynx strains the sutures; likewise
    cough, vomiting and distension.
    • Overvigorous postoperative ventilation in
    sedated patients can lead to wound
    disruption.
    Poor condition of the patient
    • Factors conducive to disruption of a laparotomy
    wound
    – Obesity
    – Diabetes mellitus
    – Immunosuppresion.
    – Uraemia
    – Jaundice
    – Malignant disease
    – Hypoproteinaemia and
    – Anaemia
    Clinical features
    • Sudden feeling of giving away.
    • Pinkish serosanguinous discharge from
    wound.
    • Open wound with bowel contents.
    Management
    • Reassure the patient
    • Cover the contents with sterile towel
    • Nasogastric tube.
    • Intavenous fluids.
    • Antibiotics
    • Tension suturing.
    Operation
    • Each coil of intestine is cleaned with saline and kept back in
    abdominal cavity
    • Fascia is strong and intact, primary closure is warranted.
    • If the fascia is infected or necrotic, débridement is performed.
    • If after débridement the edges of the fascia cannot be
    approximated without undue tension, consideration needs to
    be given to closing the wound with absorbable mesh or the
    recently developed biologic prostheses
    • All layers approximated by through and through sutures using
    nylon and applying plastic or rubber tubings to prevent
    cutting through.
    • The abdominal wall may be
    supported by strips of
    adhesive plaster encircling
    the anterior two-thirds of the
    circumference of the trunk.
    • If a partial disruption (ie, the
    skin is intact) is stable and
    the patient is a poor
    operative risk, treatment may
    be delayed and the resulting
    incisional hernia accepted
    THANK YOU

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