Wound evisceration is a serious surgical complication where internal abdominal organs protrude through a surgical incision that has opened up. It is essentially the uncontrolled exteriorization of intra-abdominal contents through a dehisced surgical wound outside of the abdominal cavity.
Understanding Evisceration
Here's a breakdown to help understand the process:
- Dehiscence: This refers to the separation or opening of a surgical wound.
- Intra-abdominal contents: These are the organs located within the abdominal cavity, like the intestines (bowel), omentum (fatty tissue), etc.
- Exteriorization: This means the organs move outside of the abdominal cavity, through the opened wound.
Key Aspects of Wound Evisceration:
| Aspect | Description |
|---|---|
| Definition | The protrusion of internal organs through a surgical wound that has opened. |
| Cause | Surgical wound dehiscence. This can result from factors like poor surgical technique, infection, increased abdominal pressure, or patient-related issues like malnutrition. |
| Severity | Ranges from mild, with only omentum protruding, to severe, where bowel loops come out. The latter is a greater cause for concern. |
| Complications | Infection, strangulation (cutting off blood supply) of the protruding organs and further damage to the abdomen. |
| Treatment | Urgent medical intervention is needed. This usually includes immediate wound covering, surgical repair, and prevention of complications. |
What Happens
During evisceration:
- The layers of the wound fail to hold together, commonly the fascial layer (strong, fibrous tissue layer below the skin) separating.
- This creates an opening, allowing internal organs to come out of the body cavity.
- Often, the small intestine is the most frequently involved organ in evisceration.
Why is it Dangerous?
Evisceration is considered a medical emergency for multiple reasons:
- Risk of Infection: Exposed organs are at a significantly increased risk of becoming infected.
- Damage to organs: Protruding organs can be damaged, twisted, or have their blood supply cut off (strangulated), leading to serious complications.
- Increased morbidity: Overall, the risk of death and severe illness increases significantly due to evisceration.
Examples
- A patient who has undergone an abdominal surgery might experience wound separation a few days post-surgery with bowel loops pushing through the wound.
- A patient might notice omentum protruding through the wound. Although less serious than bowel evisceration, it still needs treatment.
Solutions
The most important solution is prevention. This includes:
- Meticulous surgical technique.
- Proper wound care.
- Managing pre-existing patient conditions that increase risk.
If evisceration occurs, the following is necessary:
- Immediate medical attention.
- Covering the wound with sterile moist dressings until surgical repair can be performed.
- Monitoring for complications, such as infection.
In conclusion, wound evisceration is a serious postsurgical complication that requires immediate attention. It involves the separation of the surgical wound and protrusion of the intra-abdominal organs, with the greatest concern being bowel evisceration.
