title: The association of intra-abdominal infection and abdominal wound dehiscence.
abstract: Concurrent infection is a risk factor for abdominal wound dehiscence. We reviewed our experience with fascial dehiscence to determine the incidence and to identify prognostic factors for associated intra-abdominal infection. Over a 7-year period, 107 patients with abdominal wound dehiscence were identified. Seventeen were managed nonoperatively, and 90 underwent exploratory laparotomy, 43 of whom had no intra-abdominal pathology and 47 of whom had intra-abdominal infections. Demographic factors, comorbid diseases, and potential indicators of systemic infection did not distinguish patients with intra-abdominal infection from those without. Patients with an intra-abdominal infection were more likely to have undergone an emergency operation (74% vs 48%; P < 0.02), an operation on the colon (55% vs 25%; P < 0.005), or an operation with a higher wound classification (P < 0.02). Mortality was higher in patients with intra-abdominal infection than in those without (44% vs 20%; P < 0.02). Wound dehiscence after emergent operations, and operations with a higher wound classification, especially those involving the colon, should raise concern for intra-abdominal infection. Thorough abdominal exploration should be performed at the time of dehiscence repair. Before nonoperative management is chosen, intra-abdominal infection should be excluded.
authors.affiliation: Department of Surgery, Case Western Reserve University, Cleveland Veterans Affairs Medical Center, Ohio 44106, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Graham
authors.forename: J T
authors.initials: JT
authors.lastname: Stevenson
authors.forename: C R
authors.initials: CR
authors.lastname: McHenry
mesh_terms: D018784:Abdominal Abscess / Q000150:complications / Q000453:epidemiology*; D000009:Abdominal Muscles / Q000601:surgery*; D015897:Comorbidity; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D013530:Surgical Wound Infection / Q000150:complications / Q000453:epidemiology*