In medicine, a burst belly is the bursting of the surgical wound after open abdominal surgery. Potential causes of abdominal bursting include poor wound healing, obesity, and physical stress.
What is a burst belly?
Abdominal bursting is a complication following open laparotomy. A laparotomy is a surgical procedure for which the abdominal wall is opened in the abdominal area. The wound from the surgery is then sutured. The abdominal laceration occurs when the wound suture bursts and the edges of the wound gape apart. This condition is known by the technical term suture dehiscence. In this case, internal components of the abdomen protrude, that is: they push out from the interior of the body. This potentially affects organs, parts of the intestine and the mesh. The mesh is a layer of tissue that encloses the two mesenteries of the human stomach. The prolapse of the viscera is also known as prolapse or prolapsus. Medicine distinguishes between two different forms of abdominal prolapse: specialists speak of a complete or open abdominal prolapse when all the sutures on the abdomen burst open. In contrast, in incomplete or subcutaneous abdomen, the outer skin suture remains intact, while the supporting suture ruptures.
Causes
A variety of causes may underlie the burst abdomen. A hematoma (bruise) may promote the development of the abdominal laceration. A seroma can also lead to a burst belly. A seroma is a pseudocyst that contains blood serum or lymph fluid. The seroma may develop at the surgical wound if it has already closed superficially. Another potential cause of the abdominal laceration is the use of an inappropriate suturing technique when closing the wound. A strong abdominal press, in which pressure is exerted on the abdomen by heavy coughing, for example, can also cause the abdomen to burst. Similarly, excessive pressure due to mobilization too early is a possible trigger of the abdominal laceration; with rapid mobilization, overweight patients in particular are at increased risk of suffering a lacerated abdomen. Regardless of this, obesity is generally a risk factor for complications after surgery. It also potentially weakens and overstretches the abdominal wall, which also increases the likelihood of a flat belly. In particular, an excess of subcutaneous fat tissue promotes the development of the flat belly. Furthermore, the flat belly can be caused by a metabolic disorder; this has a negative effect on the healing of the wound. Decreased wound healing may also have its origin in cancer and/or associated chemotherapy or radiotherapy, diabetes, infections, liver or kidney failure.
Symptoms, complaints, and signs
The abdomen usually manifests four to six days after surgery. Patients may experience increased pain at and around the wound as a result of the abdomen. Symptomatic of complete or open abdomen are the externally visible, gaping wound edges. The open abdomen usually attracts attention during the standard inspection of the surgical suture. A corresponding control examination can also detect an incomplete or subcutaneous abdomen. However, in the case of a subcutaneous abdomen, the external suture is intact, which makes detection difficult. A possible indication of the subcutaneous abdomen is provided, for example, by the discharge of clear fluid from the wound that cannot be stopped. The secretion of fluid is caused by infection of the surgical wound, which in turn results in increased blood flow to the affected region.
Diagnosis and course of the disease
When a subcutaneous abdomen is suspected, there is a need for more detailed diagnosis, for which imaging techniques are used. Ultrasound and/or computed tomography (CT) examinations may be considered for this purpose. Detection of the burst belly as soon as possible is of great importance. The re-opened wound provides an open door for invaders such as bacteria and viruses and may result in infection of the surgical wound. Furthermore, organs, parts of the intestine as well as the mesh can prolapse and push out between the gaping wound edges. This may result in additional complications and pain.
Complications
Affected patients usually suffer from relatively severe pain at the wound after surgery. This pain can thereby spread to other regions of the body and thus also lead to pain in the back or on the flanks. The quality of life of the affected person is thus significantly reduced and limited. Furthermore, without treatment, inflammation and infection occur in the wound itself. Fluid can also leak from the wound, which cannot be staunched. Likewise, increased blood flow can occur at the wound itself. In the worst case, bleeding or blood poisoning may occur. The affected person may eventually die from this. Treatment of the burst belly is usually done by another minor surgery. This can speed up the healing of the wound so that there are no further complications. However, scars may remain from the surgical procedure or adhesions may occur. The patient’s life expectancy is not affected if the treatment is successful. Furthermore, there are no further complications after the complete covering.
When should one go to the doctor?
In any case, a burst belly must be treated by a doctor. There is no self-healing in this disease and, as a rule, the death of the affected person if the abdomen is not treated in time. Only early diagnosis and treatment can prevent further complications. As a rule, a doctor should be consulted if there is severe pain and tearing of the wound. In most cases, however, the burst belly is already noticeable during the check-up after the operation, so that it can also be treated quickly. Furthermore, leakage of a fluid from the wound can also indicate a burst belly and should be examined by a doctor immediately. Diagnosis and treatment of this condition is performed directly in the hospital, so the affected person usually does not need to see another doctor in addition. With early diagnosis and treatment, there is a positive course of the disease and the patient’s life expectancy is not negatively affected.
Treatment and therapy
In most cases, the treatment of bursting belly is surgical. The surgical procedure allows the abdomen to be inspected to rule out other causes or damage. Only then does the surgeon perform a freshening of the wound edges to allow the tissue to grow together. The new sutures often do more than just replace the old, burst wound suture. Additional sutures through tissue farther from the surgical wound can relieve pressure and tension on the actual suture. After the abdominal wall is closed, a body bandage or abdominal girdle can provide additional protection against another burst abdomen or further complications. In rarer cases, the condition is chronic and leads to what is known as a cicatricial hernia. In this case, the scarred tissue tears apart and forms the hernial orifice with this opening, through which a bag-like protrusion (inside the abdomen, since the abdominal wall is held together by the superficial suture) of abdominal wall tissue can bulge as a hernia sac. Individual intestinal loops, organs such as ovaries, or other bodily components may shift into the hernial sac. A possible consequence of chronic hernia is adhesions, which complicate treatment. The incisional hernia may enlarge over time, decreasing the likelihood of surgical success. For the treatment of chronic abdomen, surgical treatment is usually recommended after six months or a full year. However, the exact timing may vary because individual factors go into surgical planning.
Prevention
Nowadays, elastic abdominal bandages are more often used after laparotomy for prevention of the abdominal laceration. They reduce the stress on the wound suture and counteract the internal pressure of the abdomen to prevent prolapse of the internal organs.
Follow-up care
Today, the treatment after a burst abdomen can be carried out by the specialist according to a certain scheme. Then it is guaranteed that a patient will not have further difficulties. First, inspection of the abdominal cavity to rule out causal causes is important. After that, doctors can take care of the actual treatment. This can be done, among other things, by freshening the edges of the wound.Good doctors are very competent in this regard. After that, additional penetrating and removed from the wound edge sutures will be used. These can be considered as a successful treatment method. Subsequently, a new abdominal closure can be considered. Thus, it is quite possible to mitigate or completely eliminate this condition. An elastic abdominal bandage or a girdle after surgery will help the condition heal well and not recur. In any case, a patient should consult the specialists in the field. Thus, bad manifestations of the flat stomach can be very well alleviated. The recognized therapies are still used today. This is positive for the patients who have been diagnosed with this condition. In large clinics, it is possible for you to discuss all the necessary therapies with the doctors.
This is what you can do yourself
If bursting occurs, the emergency doctor must be called immediately. The bursting of a wound in the area of the abdomen represents a medical emergency, which must first be treated by an emergency physician and then further treated in the hospital. Therefore, the most important self-help measure is to immediately alert the emergency medical services. Until medical help arrives, the affected person must be given first aid. To prevent intestinal parts and organs from prolapsing, the affected person must be placed in a still position. Depending on the severity of the injury, the abdomen may be bandaged with a cloth sheet or bandage. The injured person must be calmed and immobilized until the emergency physician arrives. The medical professional must be informed of the circumstances of the abdomen (such as complications after surgery or a household accident). After hospitalization, strict rest is required. Re-opening of the wound could permanently damage the tissue and must therefore be avoided at all costs. An elastic abdominal bandage can prevent a burst abdomen. If the patient is overweight, he or she should lose the excess weight immediately after recovery to facilitate future operations and improve overall physical and mental health.
