Fascial dehiscence
Formal Definition
Partial or complete separation of the abdominal fascial closure (surgical incision through the linea alba or other muscle-fascial layers) after abdominal surgery, typically occurring 4-8 days postoperatively when the anastomotic sutures pull through weakened tissue or tension is too great; presents with sudden gush of serosanguinous fluid from the wound (the "wound pouring fluid" sign), visible or palpable bowel/organ protrusion through the incision (evisceration if full thickness), abdominal pain, often with hemodynamic instability if significant; emergency requires immediate sterile dressing, return to OR for repair, with consideration of underlying causes (poor tissue quality, malnutrition, infection, increased intra-abdominal pressure from coughing, Valsalva, ileus).
How It's Used on the Ward
"The wound blew open" or "fascial dehiscence" — when the abdominal incision breaks down days after surgery, often with a sudden gush of fluid and visible bowel underneath; OR emergency for repair; signals that the tissue couldn't hold the suture, often from malnutrition, infection, or too much abdominal pressure.
Example
""72-year-old malnourished diabetic POD#5 from sigmoid colectomy, BMI 22, albumin 2.4, on chronic steroids for COPD, has been coughing productively. Sudden gush of pink-tinged fluid from the abdominal incision while coughing, patient reports feeling "something give way." Exam: 8 cm of mid-incision separation with small bowel visible underneath. Diagnosis: fascial dehiscence with evisceration. Sterile saline-soaked gauze dressing, NPO, IV fluids, immediate return to OR for fascial repair (often with retention sutures). ICU post-op for nutritional support, infection workup.""
Clinical Context
Risk factors: malnutrition (albumin <3.0, prealbumin <20, weight loss >10%), chronic steroid use, immunosuppression, diabetes, advanced age, obesity paradoxically (despite malnutrition), wound infection, emergency surgery, increased intra-abdominal pressure (ileus, ascites, coughing, Valsalva), poor surgical technique (too tight closure, inadequate tissue bites), prior surgery at same site, hematoma. Presentation: usually POD#4 to POD#8; classic sign is sudden gush of serosanguinous fluid from the incision (the "salmon-colored Jackson-Pratt output through the wound"), followed by visible organs. Patient often describes feeling or hearing a "pop" or "give." Severity: partial (fascia separates but peritoneum holds organs in) vs complete with evisceration (organs protrude). Evisceration is a true emergency — sterile dressing, do NOT try to push organs back, immediate return to OR. Repair: depends on size and contamination; primary re-closure with retention sutures, vacuum-assisted closure, or component separation technique (advanced abdominal wall reconstruction). Mortality associated with dehiscence: 10-30%, often from underlying disease severity rather than the dehiscence itself.