[Risk factors for acute abdominal wall dehiscence after laparotomy in adults]

Total evisceration consists of protrusion of the abdominal viscera due to dehiscence of all the planes of the abdominal wall after laparotomy. The greater the number of risk factors, the greater the probability of evisceration.

We performed a retrospective study of patients with evisceration treated in the previous 9 years.

Among 12,622 patients who underwent laparotomy, 57 eviscerations were detected (45 men, 12 women; mean age 70 years). The diagnosis was peritonitis in 26 patients and intestinal occlusion in 19. Emergency surgery was performed in 48 patients. Reintervention was performed in 12 patients. Postoperative complications were found in all patients, especially wound infection and paralytic ileus. The main clinical finding was staining of the dressing. Laboratory investigations revealed leukocytosis, hypoproteinemia, and anemia. Surgical repair consisted of simple closure and/or retention sutures; mesh was associated in 6 patients. Subsequent morbidity was 77%. Twenty-six patients required admission to the intensive care unit. The mean length of hospital stay was 28.5 days. The were 41 recoveries (72%) and 16 deaths (28%). Review of 18 parameters involved in evisceration showed that 80% (45 patients) presented 9 or more risk factors.

Evisceration is a serious occurrence that produces high morbidity and mortality. The most frequent risk factors in our series were age greater than 65 years, hemodynamic instability, increased intra-abdominal pressure, emergency surgery, infection of the wound or abdominal wall, hypoproteinemia and anemia. Because these risk factors can be predicted, when several are grouped together, reinforcement should be used when closing the abdominal wall.