Postoperative wound evisceration is a serious complication that can occur following surgical procedures. It involves the protrusion of internal organs through an open surgical wound, requiring immediate medical attention.
What is Postoperative Wound Evisceration?
Postoperative wound evisceration is a severe form of surgical wound dehiscence, describing the partial or complete separation of wound edges. Evisceration occurs when the layers of the abdominal wall, including the fascia and skin, separate, allowing abdominal contents, such as loops of intestine, to protrude externally. This condition constitutes a surgical emergency due to risks of organ damage, infection, and other complications.
The sudden exposure of internal organs to the external environment places them at risk for drying, trauma, and contamination. This can lead to serious consequences, including peritonitis, sepsis, and organ necrosis if not addressed promptly. Prompt recognition and response are important to minimize adverse outcomes.
Cause One: Increased Abdominal Pressure
A primary cause of wound evisceration is a sudden or sustained increase in intra-abdominal pressure. When pressure within the abdominal cavity rises significantly, it can exert excessive force on the healing surgical incision. If this force exceeds the tensile strength of the newly formed tissue, the wound can rupture.
Common activities that can generate such pressure include coughing, vomiting, straining during bowel movements, or sneezing. Heavy lifting or other strenuous physical activities can also place undue stress on the abdominal repair. This mechanical stress can physically push internal organs through the weakened wound, leading to evisceration.
Cause Two: Impaired Wound Healing
Another primary cause of evisceration is impaired wound healing, which weakens the integrity of the surgical incision. The complex biological processes involved in wound repair, such as collagen synthesis and tissue remodeling, can be disrupted by various internal and external factors. When these processes are impaired, the wound may not achieve sufficient strength to withstand even normal physiological stresses.
Impaired healing can result from several factors. Surgical site infections can delay healing by causing inflammation and tissue breakdown. Nutritional deficiencies, particularly a lack of protein or vitamins like Vitamin C, are necessary for collagen production and can impede wound strength. Certain medications, such as corticosteroids, also suppress the immune response and hinder the body’s ability to heal effectively.
Factors Increasing Evisceration Risk
Numerous factors increase the risk of evisceration by contributing to increased pressure or impaired healing. Patient-specific conditions play a substantial role. For example, obesity can lead to increased tension on abdominal wounds and poor blood supply to fatty tissues, hindering healing. Diabetes can impair circulation and immune function, making wounds more susceptible to infection and delayed closure.
Chronic lung diseases, which often involve persistent coughing, can repeatedly elevate intra-abdominal pressure. Advanced age is associated with diminished tissue elasticity and slower healing rates. Malnutrition compromises the body’s ability to repair tissues. Smoking reduces oxygen delivery to tissues, impairing healing, and increasing the risk of respiratory complications that lead to coughing. Surgical factors, such as poor technique, excessive tension on the wound, or performing surgery in an emergency setting, can also contribute to a less robust repair, making the wound more vulnerable.
Immediate Action After Evisceration
Should postoperative wound evisceration occur, it is a medical emergency requiring immediate professional attention. It is important to avoid any attempt to push the protruding organs back into the abdominal cavity, as this can cause further damage or introduce infection. The immediate action is to cover the exposed organs to protect them from drying out and contamination.
This can be achieved by gently covering the area with sterile dressings soaked in saline solution. If sterile supplies are not immediately available, clean, moist cloths can serve as a temporary measure. The patient should be kept calm and placed in a supine position to minimize further protrusion and discomfort. Medical help must be sought without delay to facilitate prompt surgical intervention.