Clinical study of various comorbidities that lead to abdominal wound dehiscence following emergency laparotomy
MD Hussainuddin Madni, Gopinath Pai
Background and Objective: Abdominal Wound dehiscence is described as partial or complete disruption of an abdominal wound closure with or without protrusion and evisceration of abdominal contents. Wound dehiscence carries with it a substantial morbidity and mortality. The need of this study is to identify the important risk factors of abdominal wound dehiscence post emergency laparotomy.Methods: Total 180 patients undergoing emergency laparotomy were selected. Each case examined clinically and properly and an elaborative study of history based on chief complaints, risk factors, investigations, type of surgery performed and postoperative events and day of onset of wound dehiscence. Examination of wound was started from third postoperative day onwards and was continued till, suture removal and scar formation. All patients were followed up for three months.Results: The incidence of abdominal wound dehiscence is more common in male patients and in 5-6th decade. Patients with peritonitis due to hollow viscus perforation and intestinal obstruction carried higher risk of abdominal wound dehiscence. Patient with DM were more prone for wound dehiscence. Post-operative abdominal wound dehiscence was more common in patients operated with midline incision. Patients with anaemia (Hb% <10g %), jaundice and BMI less than 18 and more than 25 had higher incidence of wound dehiscence.Conclusion: Intraperitoneal infection is the most important factor in predicting burst abdomen. Malnutrition, anemia, abdominal distension correctly predict burst in every case. Investigations like Hb%, RBS, RFT, LFT may help to detect predisposing factors. Surgeon factor like midline incisions, aseptic precautions play a key role in post laparotomy wound dehiscence. Wound dehiscence can be prevented by improving nutritional status of patient proper surgical technique and correcting co morbid condition.