Prospective Study of Aetiopathogenesis and Monitoring of Intra-abdominal Pressure for Early Detection of Burst
Gulab Dhar Yadav1, Anju Yadav2, Gajendra Pratap Singh1
1Department of General Surgery, Ganesh Shankar Vidyarthi Memorial Medical College, Kanpur, IND.
Background:
The risk of evisceration, the need for rapid treatment, and the possibility of recurrent dehiscence make burst abdomen a severe postoperative complication that surgeons must deal with. A wound's dehiscence is linked to severe morbidity and mortality. This study examined how rapidly abdominal burst and wound dehiscence could be identified in patients after both emergency and scheduled laparotomies.
Methods:
This prospective study included 80 patients with burst abdomens, aged more than 18, who underwent exploratory laparotomies in the Department of General Surgery, LLR, and associated hospitals, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College from January 2021 to October 2022. Various factors were observed, such as postoperative wound infection, nutritional status, raised intra-abdominal pressure, type of pathology, and patients undergoing emergency or elective exploratory laparotomy.
Results:
The presence of intra-abdominal sepsis (63.75%), anemia (61.25%), and hypoproteinemia (50%) favors a higher incidence of burst abdomen as preoperative risk factors. Among various pathologies, gastro-duodenal perforation (30.0%) was found to be the most common pathology associated with a burst abdomen. In the postoperative period, wound infection (77.5.0%) was the most common factor associated with a burst abdomen, followed by raised intra-abdominal pressure (due to cough (35%), vomiting (17.5%)), and postoperative abdominal distension (27.5%). Intra-abdominal pressure was found to be a very sensitive early predictor of wound dehiscence, with peak incidence on POD-6 (IAP>16 mmHg).
Conclusion:
Emergency procedures are more likely than elective surgeries to result in a burst abdomen. Anemia and wound infection both raise the risk of abdominal rupture. Intra-abdominal pressure was found to be a very sensitive early predictor of wound dehiscence. In both the treatment and prevention of this disorder, adherence to good methods and serious attempts to reduce the influence of predisposing variables are much more important.
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