Wound Evisceration

Wound evisceration is extrusion of intra abdominal viscera through a disrupted abdominal surgical wound.

It is a surgical emergency.

The exposed bowel is vulnerable to desiccation, direct trauma, venous congestion, strangulation and perforation.

Bowel or omentum is visible through the abdominal wound.

It may follow complete fascial dehiscence after coughing, vomiting, straining or wound infection.

Assess simultaneously for:

• Shock
• Bowel colour and obvious ischaemia
• Active bleeding
• Peritonitis
• Purulent contamination
• Respiratory compromise from pain or abdominal pathology

Diagnosis is clinical.

Imaging has no role before theatre when evisceration is obvious.

Call the surgical and anaesthetic teams immediately.

Keep fasting and establish IV access.

Place the patient supine and minimise movement.

Cover exposed viscera with sterile gauze soaked in warm normal saline.

Do not allow bowel to dry.

Do not apply antiseptic directly to exposed intestine.

Do not force bowel back into the abdominal cavity at the bedside.

Correct haemodynamic instability and significant electrolyte abnormalities while theatre preparation proceeds.

Give broad spectrum antibiotics when contamination or infection is present. Following gastrointestinal surgery:

Piperacillin tazobactam 4.5 g IV every 8 hours by extended infusion, adjusted for renal function.

Emergency operative exploration is required.

At operation, assess bowel viability before reduction. Resect only clearly nonviable or perforated bowel.

Identify the cause of wound failure, wash out contamination where present and debride infected or devitalised fascia.

Close the fascia when possible without excessive tension. If safe primary closure cannot be achieved, temporary abdominal closure is preferable to a tight closure that creates recurrent fascial failure or abdominal compartment syndrome.