Fascial dehiscence after trauma laparotomy: a sign of intra-abdominal sepsis.
Fascial dehiscence (FD) after trauma laparotomy is associated with technical failure, wound sepsis, or intra-abdominal infection (IAI). The association of IAI with FD is inadequately evaluated. Knowing about its presence is essential to guide clinical diagnosis and management. Our objective was to identify the incidence and risk factors of IAI in patients with FD. We performed a medical record review of 55 trauma patients with FD. Patients with IAI were compared to patients without IAI and FD patients to all trauma laparotomy patients during the same period. Statistical significance was at P < 0.05. Thirty-nine (71%) FD patients had IAI, significantly higher than all trauma laparotomies (4.6%, P < 0.0001). Only 31 per cent of patients underwent laparotomy and drainage while 69 per cent received CT-guided percutaneous drainage followed by expectant management. Similarly, 33 per cent of the non-IAI group had operative management. No differences were found between the two groups in any of the examined factors. The majority of trauma patients with FD have IAI. No clinical or laboratory factors help identify FD patients likely to have IAI. Therefore, FD should be viewed as a sign of possible underlying IAI. Appropriate radiographic imaging or direct visualization of the entire abdominal cavity should be pursued before managing the dehisced fascia.
Tillou
Areti
A
Department of Surgery, Trauma and Critical Care, University of Southern California, LA County/USC Medical Center, Los Angeles, California 90033, USA.
Weng
Janie
J
Alkousakis
Theodore
T
Velmahos
George
G
D000005:Abdomen; D000007:Abdominal Injuries / Q000601:surgery*; D000328:Adult; D004322:Drainage; D000071938:Fasciotomy; D005260:Female; D006801:Humans; D007813:Laparotomy; D008297:Male; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis*; D015641:Radiography, Interventional; D012307:Risk Factors; D018805:Sepsis / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D013529:Surgical Wound Dehiscence / Q000150:complications* / Q000175:diagnosis; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000628:therapy; D014057:Tomography, X-Ray Computed