Postoperative abdominal evisceration in children: possible risk factors

Abstract

Postoperative abdominal evisceration may lead to high morbidity and mortality. The purpose of the present study was to determine possible risk factors, morbidity and mortality associated with abdominal evisceration in children. A total of 3,591 children underwent abdominal exploration in our clinic between 1983 and 2005. In this study, we retrospectively reviewed 29 patients who developed abdominal evisceration after abdominal exploration. The incidence for abdominal evisceration was found to be 0.8%. The mean age was 16 months (range 1 day-13 years), while 48.2% of the patients were younger than 1 month. The incidence of abdominal evisceration was significantly higher in patients younger than 1 month (2.5%) compared to older ones (0.4%) (P < 0.0001). The mean time interval between primary abdominal exploration and development of abdominal evisceration was 7 days (2-21 days). The risk for development of evisceration was significantly higher in patients who underwent colonic or small bowel surgery compared to those underwent laparotomy alone (P < 0.0001, P < 0.01, respectively). Absorbable suture was used in 15 patients for closure of abdominal fascia, while a silk suture material was used in 14 patients (P > 0.05). The age-weight percentile was lower than 3% in 41.3% of patients. At the follow-up period, 19 patients recovered completely whereas 10 (34.5%) died. As a result, the age (neonates), primary surgery (colo-rectal), type of incision (median), and emergency surgery were significant risk factors for development of abdominal evisceration in children.

The range of abdominal surgical emergencies in children older than 1 year at the komfo anokye teaching hospital, Kumasi, Ghana

“…The worse complications in this series included enterocutaneous fistulas and complete wound dehiscence (burst abdomen), these two being associated with high morbidity and mortality. [31] More deaths were recorded in the TP group when compared to the groups with other disease entities. Mortality in the series was 9.7%, and this was mainly due to deaths in the TP group.…”

Outcomes of early relaparotomy in pediatric patients at Tikur Anbessa teaching hospital, Addis Ababa, Ethiopia: a five-year retrospective review

“…In a series of 121 relaparotomies in 16,719 cases of laparotomy in Sweden, indications for relaparotomy have included peritonitis (32%), ileus (25%), wound rupture (22%), hemorrhage (19%), and other causes (2%) [ 9 ]. In studies done on pediatrics shows postoperative abdominal evisceration in children accounts for 0.2–1.2% and is one of the indication for relaparatomy [ 10 , 11 ].…”

“…This figure is very similar to studies conducted in Sweden and Russia, which found mortality rate of 28.1 and 26%, respectively [ 8 , 9 ]. And those patients who were managed for wound dehiscence in the above literatures has mortality rate of 11 and 12.5% [ 10 , 11 ]. The majority (90.6%) of deaths following relaparotomy were attributed to multisystem organ dysfunction due to sepsis.…”

Effect of retension sutures on abdominal pressure after abdominal surgery

“…The research of Gurleyik et al 45 indicated that retention sutures can increase abdominal pressure, which was reported to be a risk factor for abdominal wound dehiscence. In addition, abdominal hypertension can delay the return to a normal diet by mouth in elective abdominal surgery patients, 46 increase the rate of re-operation in patients with abdominal trauma, 47 and even result in abdominal cavity organ dysfunction. 28 , 29 , 30 , 48 , 49 High IAP reduces abdominal blood flow, which causes local edema and necrosis.…”

“…In addition, the wound dehiscence rate after abdominal surgery was 0.4%–3.5%, which was much lower than the IAH incidence after abdominal surgery (12%) reported in other studies. 5 , 6 , 7 , 11 , 37 , 46 , 58 , 59 …”