What is evisceration (protrusion of internal organs through a wound or surgical incision)?

From the Guidelines

Evisceration, in the context of surgical site infections (SSIs), is a serious complication that requires prompt and effective management to prevent morbidity, mortality, and to improve quality of life. When considering the management of evisceration, it is crucial to prioritize the most recent and highest quality evidence available.

Key Considerations

• The management of SSIs, including evisceration, involves a comprehensive approach that includes drainage, irrigation, and if necessary, opening and debridement of the wound 1.
• The use of antibiotic-coated sutures has been shown to significantly reduce the rate of SSIs in emergency settings, and their use is recommended when available 1.
• Retention sutures may be considered in patients with high-risk conditions for incisional hernia and wound dehiscence, but their use is not universally recommended due to the potential for increased postoperative pain 1.

Management Approach

• Incisional SSIs should always be drained, irrigated, and if needed, opened and debrided to prevent further complications and promote healing 1.
• The use of empiric broad-spectrum antibiotic treatment should be considered in patients with systemic inflammatory response criteria or signs of organ failure 1.
• Postoperative care should include wound dressing changes, antibiotic ointment application, and oral antibiotics as necessary to prevent infection and promote healing.

Quality of Life Considerations

• Patients with evisceration should be closely monitored for signs of infection, wound dehiscence, and other complications to prevent morbidity and mortality.
• Pain management should be prioritized to improve patient comfort and quality of life.
• Patients should be educated on wound care and follow-up appointments to ensure proper healing and prevent further complications.

From the Research

Definition and Causes of Evisceration

• Evisceration is a rare but life-threatening complication that can occur after various surgical procedures, including hysterectomy 2 and diverting stoma creation 3.
• It can also result from abdominal stab wounds 4, 5 and other forms of trauma.
• The causes of evisceration can be attributed to various factors, including surgical failure, trauma, and spontaneous necrosis 3.

Clinical Presentation and Diagnosis

• The clinical presentation of evisceration can be non-specific, making prompt recognition and diagnosis crucial 2.
• Patients may present with sudden onset severe abdominal pain, vomiting, and the sensation of vaginal fullness or a large prolapse per vagina 2.
• Physical examination may reveal a vaginal vault prolapse with eviscerated small bowel or other organs 2.

Management and Treatment

• Evisceration is a gynaecological emergency that requires immediate recognition and management via a multidisciplinary approach 2.
• Management involves assessing for and controlling associated hemorrhage, assessing for bowel content leakage, covering the eviscerated abdominal contents with a moist, sterile barrier, and carefully reassessing the patient 6.
• Surgical repair is often necessary, and various approaches have been described, including emergency laparotomy and local surgical approaches 2, 3, 4, 6, 5.
• Antibiotics should be administered for any open wounds, including abdominal eviscerating injuries 6.

Outcomes and Prognosis

• The outcomes for patients with evisceration can be improved with appropriate prehospital management and prompt surgical intervention 6.
• Mortality in abdominal evisceration is more likely to be secondary to associated injuries than to the evisceration itself 6.
• The prognosis for patients with evisceration depends on various factors, including the severity of the injury, the presence of associated injuries, and the timeliness and effectiveness of treatment 4, 6, 5.