Space belly
| Classification according to ICD-10 | |
|---|---|
| T81.3 | Surgical wound tear, not elsewhere classified |
| ICD-10 online (WHO version 2019) | |
The abdomen is a spontaneous rupture of a laparotomy wound with fascia dehiscence ( dehiscence = divergence) and prolapse (protrusion) of the mesh , intestinal parts or organs.
The space belly is a medical term. It is used to describe an undesirable complication after an abdominal surgery with often visible herniation of the viscera. Other terms that are sometimes used synonymously are wound dehiscence or abdominal suture insufficiency, although these do not describe the condition with sufficient precision.
The code for burst abdomen (excluding caesarean section and obstetric dam sore) in the international disease classification is T81.3 .
Classification
To distinguish is one
- complete or open space belly with tearing open all belly seams and a
- Incomplete or subcutaneous space belly in which the load-bearing seam layer tears but the skin seam still holds.
One could also differentiate an acute from a chronic space abdomen, only the latter is adequately covered by the technical term incisional hernia.
diagnosis
Typically this event occurs between the 4th and 6th postoperative day. The diagnosis of the acute, complete abdomen is easy to make, as this can usually already be recognized during the wound inspection. An incomplete space belly is not so easily recognizable. An insatiable clear (serous) wound secretion gives an indication. Allows ultrasound and CT confirm the diagnosis.
Pathogenesis and etiology
The abdomen is not a rare complication of an abdominal surgery. The space belly is favored by
- strongly fluctuating abdominal pressures
- Coughs
- Careless, too rapid mobilization after operations (in overweight patients)
- long-lasting increase in abdominal pressure
- decreased healing through
- diabetic micro- and macroangiopathy
- chronic renal failure
- consuming diseases ( cancer )
- chronic liver damage
- acute, uncorrected metabolic disorders
- Wound infection
- Chemotherapy , radiation
- overstretched or weakened abdominal wall
- Obesity
- large abdominal incisions ( large incisions are unnecessary with laparoscopic surgery, which reduces the number of wound complications).
prevention
You can counteract the abdomen with an elastic bandage. Unfortunately, the compression of the corset restricts the breathing volume (vital capacity) considerably and is therefore no longer accepted without criticism. But this method is still recommended for mobilization after operations on abdominal wall hernias .
Before elective surgery , overweight patients should be motivated to reduce their excess weight.
treatment
The acute event is usually operated on urgently:
- Inspection of the abdominal cavity to rule out causal causes,
- Freshening the wound edges,
- additional, sweeping, relieving sutures removed from the wound edge (still favored by many surgeons) and finally
- renewed abdominal wall closure.
- postoperative abdominal girdle or an elastic bandage (see above)
Chronic courses or conservatively treated, covered space bellies lead to a hernia . This will then be treated surgically after six months to a year at the earliest.
