EVENTRATION

From Big Medical Encyclopedia

EVENTRATION (Latin e[x] - the prefix meaning department, + venter a stomach; a synonym loss of interiors) — loss of internals from an abdominal cavity through defect of its wall.

Distinguish outside (open), internal (intrapleural) and hypodermic E. At outside E. abdominal organs drop out through a wound of an abdominal wall on a body surface. Internal E. it is characterized by loss of abdominal organs through a wound of a diaphragm in a pleural cavity. Hypodermic E. arises usually after a laparotomy (see) in cases of discrepancy of seams on a peritoneum, muscles and an aponeurosis at nerazoshedshikh-sya seams on skin. AA. differs from hernia (see) lack of the hernial bag covered by a peritoneum.

Most often E. it is observed at cut and chipped and cut wounds of a front abdominal wall (see). At a torak abdominal damages (see) internal E. usually occurs in the left pleural cavity since on the right the wound of a diaphragm is covered by a liver. On summary statistics of A. V. Melnikov, during the Great Patriotic War E. it was noted at 13,8 — 23,2% of the wounded operated concerning wounds of a stomach. After abdominal organs operations, according to N. 3. Monakova, AA. it is observed in 3% of cases. At all types E. in a wound the big epiploon (49% of cases) and a small bowel (29% of cases) most often drop out.

Usually reason postoperative E. suppuration of an operational wound or peritonitis is (see). At the exhausted patients (a nutritional dystrophy, malignant new growths, hypovitaminosis, traumatic exhaustion) E. can come also without suppuration of an operational wound. The meteorism, paresis of intestines, cough, vomiting, and also technical errors at suture on a wound promote discrepancy of its edges from the subsequent

E. E. after a laparotomy can arise in different terms, but most often during the period from the 6th to 12th day after operation. At the same time the bandage suddenly plentifully gets wet with serous and hemorrhagic liquid, and sometimes from under it abdominal organs drop out.

AA. serves as the indication to an immediate surgery. In the absence of peritonitis and suppuration of a wound the dropped-out bodies irrigate with solution of antibiotics, set in an abdominal cavity, and layer-by-layer take in a wound of a front abdominal wall tightly so-called matratsny, or lamellar, seams (see Seams surgical), to-rye impose thick silk, lavsan, kapron thread. Seams carry out through all thickness of an abdominal wall, far receding from edges of a wound. Remove seams not earlier than on 12 — the 14th day. At suppuration of a wound or peritonitis after careful reposition of the dropped-out loops of intestines the wound is filled with tampons with a liquid paraffin or fish oil and apply an aseptic bandage. Sometimes on a front abdominal wall over a bandage impose a plaster splint.

At E. in cases of the getting wound of an abdominal cavity it is always necessary to assume an internal injury and to carry out careful audit of an abdominal cavity. If blood supply and Hermeticism of a wall of the intestinal loop which dropped out in a wound are not broken and it is not covered with imposings of fibrin, then the intestinal loop is washed solution of antibiotics and antiseptic agents and immersed in an abdominal cavity. The dropped-out epiploon is resected.

At internal E. the urgent thoracolaparotomy, a resection or reposition of the bodies which dropped out of an abdominal cavity in pleural and sewing up of a wound of a diaphragm is shown.

Prevention postoperative E. consists in careful suture, the prevention, early identification and treatment of suppurations of an operational wound, fortifying treatment, the prevention and rational treatment of paresis of intestines and pulmonary complications.

Bibliography: Alperovich B. I. and

C x and y V. F. Treatment of eventration, Surgery, No. 3, page 112, 1978; Guests -

shch e in V. K. and d river. Postoperative eventrations, Vestn. hir., t. 128, No. 4,

page 132, 1982; Nikiforov B. I., Katz V. I. and Averyanov of A. P. Eventration in a purulent wound, Klin, hir., Ns 1, page 36, 1982; Experience of the Soviet medicine in the Great Patriotic War of 1941 — 1945, t. 12, page 45, 412, M., 1949; Rodionov V. V., etc. Postoperative eventrations, Surgery, No. 10, page 84, 1979; Pants A. I. The reasons of eventrations and the indication to relaparotomy at children, Vestn. hir., t. 118, No. 1, page 89, 1977; III and p to and V.'s N of Page and X about r e in G. N. Tactical and technical issues of treatment of eventrations, Klin, hir., No. 1,

page 52, 1977. R. T. Panchenkov.

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