While on call for the surgical ward, you are urgently called to the bedside of a patient who underwent an open exploratory laparotomy six days ago. The patient had a severe coughing fit and reported feeling a sudden 'popping' sensation in the abdomen. On examination, the surgical dressing is saturated with serosanguinous fluid. When you carefully lift the dressing, you observe that the fascial layer has separated and loops of small intestine are protruding onto the abdominal wall. Arrange the following immediate management steps in the most appropriate chronological order.
- 1Instruct the patient to remain in bed and flex their hips and knees.
- 2Cover the protruding bowel loops with sterile towels moistened with warm normal saline.
- 3Contact the attending surgeon and anesthesiologist to activate the operating room.
- 4Transfer the patient to the surgical suite for emergent operative repair.
Cevap
The correct chronological management of wound evisceration is to first reduce abdominal tension by positioning the patient with flexed knees, followed immediately by covering the exposed viscera with sterile, saline-moistened dressings. Next, the surgical team must be notified to prepare the operating room, and finally, the patient is transported for definitive surgical closure.
Wound evisceration is a surgical emergency requiring immediate and systematic intervention. The first goal is to prevent worsening of the condition by reducing intra-abdominal pressure (positioning). The second goal is organ preservation by preventing the exposed bowel from drying out (saline dressings). Once stabilized at the bedside, the team must coordinate definitive care (calling the OR) and then execute it (transporting the patient).
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Anahtar Kavram
Immediate sequential management of postoperative wound evisceration