Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study

Abstract

Background: Incisional complications are a common cause of morbidity following laparotomy. Although uncommon, acute abdominal dehiscence (AAD) is a potentially fatal post-operative complication. However, few AAD cases are described in the literature. Objectives:To describe common features of cases of AAD following ventral midline laparotomy, management and outcomes. Study design: Retrospective case series.Methods: Hospital records of horses that underwent a ventral midline laparotomy at nine hospitals in the UK, Ireland and USA over a 10-year period (2009-2019) were reviewed. Data were collected for pre-, intra-and post-operative factors that were considered relevant. Descriptive statistical analysis was performed.Results: A total of 63 cases of AAD were identified. AAD occurred due to tearing of sutures through the linea alba or rupture of the body wall adjacent to the suture line in 46 horses (73%). AAD occurred at a median of 5 days (0.5-70 days) postoperatively and broodmares accounted for 25% of the cases (n = 16). Surgical site infection developed prior to AAD in 28 horses (44%); leakage of peritoneal fluid occurred in 5% of horses prior to AAD being identified. Surgical repair was performed in 27 horses (43%), 10 (16%) were treated conservatively and 26 (41%) were euthanised immediately. Repair was most frequently performed using suture (n = 14), wire (n = 5) or a combination (n = 5). Overall survival to hospital discharge was 39% (24/63). Where surgical repair was performed, 15 horses (56%) survived to hospital discharge; 9 horses (90%) managed conservatively survived to hospital discharge.Main limitations: Follow-up was not performed for all cases following hospital discharge and some data were incompletely recorded in hospital files.

Evisceration in a Thoroughbred gelding following application of a topical chemotherapy agent for the treatment of sarcoids

“…Evisceration of the abdominal contents can be a fatal event in horses and has been recorded following castration (Moll et al, 1995), due to acute abdominal dehiscence of a ventral laparotomy incision (Hann et al, 2022) or subsequent to penetrating abdominal wounds (Netto et al, 2006). Prognosis for survival decreases with increasing time, deteriorating condition of the horse, length of intestine eviscerated, intestinal damage or contamination and the requirement for intestinal resection anastomosis (Thomas et al, 1998; Van der Velden, 1988).…”

Evisceration in a thoroughbred gelding following application of a topical chemotherapy agent for the treatment of sarcoids.

“…Evisceration of the abdominal contents can be a fatal event in horses and has been recorded following castration (Moll et al 1995), due to acute abdominal dehiscence of a ventral laparotomy incision (Hann et al 2022) or subsequent to penetrating abdominal wounds (Netto et al 2006). Prognosis for survival decreases with increasing time, deteriorating condition of the horse, length of intestine eviscerated, intestinal damage or contamination, and the requirement for intestinal resection anastomosis ( Van der Velden 1988;Thomas et al 1998).…”

What do we currently know about incisional complications of colic surgery?

“…Infection of the incision adds expenses, extends hospitalisation and serves as a risk factor for further complications; including dehiscence and hernia formation (French et al, 2002; Honnas & Cohen, 1997; Ingle‐Fehr et al, 1997; Mair & Smith, 2005; Smith et al, 2007). These additional complications can in turn negatively affect future athletic performance and even survival (Davis et al, 2013; Hann et al, 2022).…”

“…According to one study, on a small number of horses, draught breeds were found at increased risk for AAD (Gardner & Mudge, 2017). Recently, however, a thorough, multicentric retrospective study was published (Hann et al, 2022). Hann et al reported that contrary to previous assumptions, AAD is not typically preceded by peritoneal fluid leakage from the incision (occurred in only 5% of cases), or by post‐operative colic or violent recovery (occurred in 24% of cases) (Hann et al).…”

“…A significant proportion of the reported AAD was pre‐ or post‐partum mares (25%) and most cases (65%) were bandaged prior to dehiscence. Overall, in that study, nearly 40% have survived to discharge but once intestinal protrusion was visible, less than 20% survived (Hann et al, 2022). Horses that had surgical repair of AAD had a fair prognosis (56%) while horses that were treated conservatively via an abdominal bandage had an excellent prognosis (90%), but none of the horses with eventration were treated conservatively (Hann et al, 2020).…”