Evisceratia

Evisceratia Viscera of the abdomen is Evisceratiile out to the outside by a solution of continuity in the abdominal wall, or postoperative trauma occurred. Evisceratiile penetrating abdominal wounds are caused by trauma which often are accompanied by visceral injury complicated by infection, and in this case must be made in emergency surgery. Contributing factor in postoperative Evisceratiile following: suppurative wound, type of laparotomy performed, immediate postoperative complications (eg acute urinary retention that increases intra-abdominal pressure), factors related to the biological background of the patient (age, consumptive diseases, large physical effort, and small, and repeated, obesity). The anatomic and clinical point of view there are three forms of evisceratii: evisceratii incomplete (subcutaneous) complete evisceratii (suprategumentare) and evisceratii locked or secured. Patients with evisceratie besides visceral externalizing problems, cardio-circulatory, respiratory distress, shock. Evisceratiilor Treatment varies depending on their condition. In the infected recommend refraining from surgery in the absence of deep abscesses and necrotizing tubular device or installing a continuous lavage and suction drainage suppurations where these exist. These patients need intensive supported that includes antibiotics, blood proteins. Evisceratiilor treatment is surgical and consists of infected viscera reintegration and rehabilitation of the abdominal wall. If infected evisceratiilor prognosis remains reserved even with modern means of resuscitation.
ETIOPATHOGENIC
Determinants are represented by increased intra-abdominal pressure and poor healing. Contributory factors are represented by respiratory diseases, prostate, postoperative ileus dynamic, early lifting effort. The land is of major importance and patient factors predisposing to evisceratii are malignancies, obesity, hypoproteinemia, renal failure, hunger, jaundice, severe anemia, diabetes mellitus, immunosuppressive therapy, alcoholism, respiratory failure, advanced age. Local factors are represented by vertical and paramedian incisions, suture tension, legal persons will receive infection, tissue injury parietal importantly, inadequate suture material and technique.
TYPES OF EVISCERATII
Evisceratia incomplete, appears in the first week after surgery and is manifested by the appearance of a bloody secretions among HIV-suture, followed by protrusion of viscera to the skin, clinically manifested by vomiting, flatulence, ileus dynamic appearance of a subcutaneous tumor at exteriorized viscera represented. Full-Evisceratia, freedom, consist dezunirea all parietal layers with full or partial exteriorization of the viscera in the wound according to wound involving partial or total, the clinical picture is noisy and is manifested by hiccup, dynamic ileus, vomiting, bloody infiltration of dressing with protrusion of the omentum and small bowel loops through the suture thread. Fixed or locked-Evisceratia occurs after the first week and in this situation viscera outwardly, but remain attached by a process of plastic peritonitis, usually this is caused by type evisceratie deep wound infection.
SIGNS AND SYMPTOMS
Evisceratiile are accompanied by shock, respiratory and cardio-vascular disorders arising due to pain and loss of traction on mezouri liquid surface loops. Bowel can be present or absent. Complete Evisceratia occurs early, the other two types (fixed and incomplete) occur late and are preceded by restlessness, nausea, vomiting, wound pain, fullness and secretions from the wound. After a lively effort by the patient perceives pain sensation from the wound rupture. Local examination of all plans parietal dehiscence found with externalizing evisceratiilor viscera in dressing if available, and if found incomplete dehiscence of keeping skin wall, deformation occurs by migrating wound viscerelui subcutaneously. Local examination showed in evisceratia blocked relaxed sutures, which cut the wall, purulent discharge from the wound and the wound lips are atonic.
TREATMENT
Treatment varies depending on the type of evisceratie. If conservative treatment is evisceratiilor blocked toilet consists of local, near lip wound suction drainage, local and systemic antibiotics. For evisceratiile blocked wall suppurativa can use a chloramine solution irrigation. Evisceratii other types of emergency benefits of surgical treatment consisting of wound toilet and the peritoneum and abdominal wall rehabilitation. The main objective of surgical cure is to reduce the chances evisceratiilor free in the abdominal cavity and abdominal wall rehabilitation.
Surgical technique The first time the toilet is to wound and peritoneum, is completely open wound, to solve the parietal abscess, adhesions viscero-visceral and viscero-parietal ones, wash the peritoneal cavity with intestinal chances with saline, antiseptic solution and antibiotic solution, intestinal then chances are returned into the abdomen. The second time is to restore the wall, remove sfacelurile and necrotic areas in the wall until it reaches the tissue, then the wall is sutured with wires in total military plan, which plan and catch muscle. You can also use open-abdomen technique, which consists of placing a sheet of polyurethane sepraphil or an elastic bandage to keep the abdominal contention, and after a few weeks following musculo-aponeurotic suture holes.
Postoperative care and prognosis General treatment is aimed at improving general condition and nutritional status of the patient, fight infection and acid-base imbalances. An elastic bandage maintains visceral contention. Pharmacological Contenta continue contention mechanical respiratory assistance allows, avoiding coughing and vomiting. Patient's prognosis depends on the terrain, the condition for which originally occurred, and the complexity of primary surgery. Increased frequency evisceratiilor remains a problem and are accompanied by a significant morbidity and mortality.